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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