Modernizing Medicare Part D Will Make Medicines More Affordable

As the population ages, it’s critical that the United States continues to expand access to valuable medications that have contributed to increased life expectancy and healthy, active lifestyles.

My father suffered from Alzheimer’s disease, which stretched and strained my family both financially and emotionally. This experience has driven my desire to do what’s right for this population. And, today, I help address access and affordability issues in Washington, D.C.

The good news is that, in 2003, a law known as the Medicare Prescription Drug, Improvement and Modernization Act — or simply Medicare Modernization Act (MMA) — provided all Americans 65 and older with access to prescription drug coverage.

But the past 15 years have shown that we can do more for seniors when it comes to the Part D drug benefit. While the benefits have been transformational, the law does not do enough for all Americans, especially those who rely most heavily on critical therapies.

Unlike the insurance that most Americans get from their employers, Medicare Part D has some gaps in which seniors are asked to pay more than they would with other insurance options.

It is time to modernize the program in a way that provides greater affordability without eroding support for the research and innovation that is essential to providing new treatments that address the growing unmet needs of the next generation of Medicare beneficiaries.

Unfortunately, most drug price proposals have failed to make these simple changes to expand access. Instead, policymakers are focused on legislation that would allow the government to dictate prices for medicines in Medicare that may be politically popular but ultimately won’t have the intended effect of making medicines more affordable. Worse still, such legislation would have a devastating effect on all patients — certainly to our older adult population — as the pipeline of tomorrow’s cures would slow to a trickle. As an alternative, Congress should focus on important steps we can take to update Medicare Part D that will improve affordability without disrupting innovation, such as:

1. Cap out-of-pocket costs. There is currently no cap on spending in Part D. Patients with large bills for their medicine must pay at least 5% of their drug costs, causing financial damage and a lack of predictability. Given that Part D is supposed to be an insurance benefit that should protect against such situations, the current status quo is unworkable, especially for those seniors managing multiple chronic diseases. The latest proposal being debated in Congress includes a cap on out-of-pocket prescription drug costs. Let’s hold Congress accountable and make this a win for patients.

2. Reduce the coverage gap. Commonly known as the “donut hole,” the coverage gap is a temporary limit on your prescription coverage. Once a beneficiary reaches the gap, they are responsible for 25% of the cost. That number should be lowered to 20 or 15%. Make the pharmaceutical industry pay the difference.

3. Spread out-of-pocket spending over a longer period. Families caring for sick loved ones can generally incur high costs for medical care and prescriptions, especially in the early months of the calendar year when deductibles reset. We should shift these health care costs back to the second quarter of the year to allow for more recovery time and breathing room for families. This will require partnership from healthcare providers and payors, but it is an avenue worth considering.

4. Share savings directly with patients. The plans that administer Medicare Part D receive large rebates on branded medicines. These rebates have been growing but have not been used to lower out of pocket costs for patients. Passing these savings on to the individual patients will provide immediate financial relief.

We can all agree more must be done to alleviate the financial burden on those living with disease. These Part D reforms keep patients and their families front and center, ensuring they will continue to have access to groundbreaking therapies when they need them most — a vast improvement over the legislation currently being considered in Washington that promises to hinder innovation and severely limit patient access to medicines.

Shawn O’Neail is a government relations professional with more than 20 years of experience. He is currently vice president of government affairs at Eli Lilly and Company, where he develops and executes federal and state legislative strategies on Capitol Hill.

This article was created in partnership with GET Creative, a division of USA Today.