Senate plan to cap out-of-pocket costs in Part D could save some seniors thousands, study finds

A Senate proposal to cap out-of-pocket spending for Medicare beneficiaries could save seniors with hefty prescription drug bills thousands of dollars every year, STAT reported.

The proposal is part of the Prescription Drug Pricing Reduction Act of 2019, introduced by Sens. Chuck Grassley, R-Iowa, and Ron Wyden, D-Ore, and seeks to cap out-of-pocket spending in Medicare Part D at $3,100.

The cap wouldn’t affect most seniors because their out-of-pocket spending doesn't typically reach the $3,100 threshold, according to a paper published in the New England Journal of Medicine. However, the cap could save about $4,000 every year for patients who rack up annual drug bills of $100,0000.

Under the current Medicare rules, seniors split the cost of their prescriptions with drugmakers, insurers and the federal government. Once their prescription costs reach $8,000, seniors are responsible for 5 percent of the costs. But, because there's no cap in place, they have to pay 5 percent of their drug bill no matter how high the bill gets.

According to STAT, there isn't clear data on how many seniors have more than $100,000 in prescription bills annually, but it's likely becoming more common as high-cost drugs for complex conditions like cancer hit the market.

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