Medicare's prescription drug program, Part D, is an essential program that provides coverage for critical prescription medications. The program is particularly important for beneficiaries with kidney disease, many of whom also have other medical conditions that may require them to take medications covered under Part D.
However, within the current Part D benefit structure, there is no true annual out-of-pocket (OOP) cap for beneficiary cost-sharing. If you are a beneficiary who does not qualify for a low-income subsidy, you will still have to pay 5% coinsurance on your covered prescription medications for the rest of the year once you reach the so-called "catastrophic" phase of Part D coverage. There is no limit on how much you will pay each year. This is a significant financial burden on people with serious medical conditions like end-stage renal disease — that require expensive drug therapies to manage their conditions. The high OOP costs can also lead to beneficiaries forgoing necessary medications, which can lead to worse health outcomes.
As Congress continues to consider legislation to pass before the end of 2021, it is important that they include a redesign on the Part D program that finally includes a true OOP cap for beneficiaries. It is also important that they include a "smoothing" mechanism for beneficiaries to pay their OOP costs. A smoothing mechanism would allow beneficiaries who reach the new OOP cap early in the benefit year to spread those OOP costs throughout the year instead of having to pay it all at one time. These changes to the Part D program would ensure beneficiaries with significant prescription drug needs would be better able to afford their medications.
Please contact your federally elected officials and ask them to support a Medicare Part D OOP cap with a smoothing mechanism by clicking below.