September 17, 2018
Xcenda Experts Develop Report on History and Success of Medicare Part D on its 15th Anniversary
Fifteen Years of Part D: Gaining Perspective on the Medicare Prescription Drug Benefit
Xcenda is proud to contribute to a new report recently released by Medicare Access for Patients Rx (MAPRx) on Medicare Part D. Findings reveal the program is as popular and robust as ever, but faces challenges that could result in increased costs and limited access for millions of beneficiaries. The study titled, “Fifteen Years of Part D: Gaining Perspective on the Medicare Prescription Drug Benefit,” was commissioned by MAPRx to commemorate the 15th anniversary of Part D.
Key highlights of the report include:
- Without congressional action, Medicare Part D beneficiaries will experience an increase of $1,250 in out-of-pocket spending to reach the catastrophic coverage phase in 2020. This dramatic cost increase, known as the “out-of-pocket cliff,” combined with other proposed policy changes, could devastate beneficiary access to needed medications. The report affirms that an “out-of-pocket cap would offer significant relief.”
- One factor driving high out-of-pocket costs is the actual drug price beneficiaries must pay at the point-of-sale, particularly in instances where a beneficiary faces a deductible or a coinsurance. In Part D, the price at the point-of-sale is based on the list price and does not account for any rebates or discounts that might reduce the overall price. Applying rebates “at the point-of-sale” would ensure that beneficiaries and the government could benefit from these lower costs.
- The proliferation of specialty tiers, subject to significant coinsurance and excluded from cost-sharing exceptions, forces beneficiaries to pay a significant percentage of the medication’s cost. For drugs covered on the specialty tiers, the coinsurance amounts can range anywhere from 25 percent to 33 percent, leaving beneficiaries paying thousands of dollars in out-of-pocket costs for drugs and biologics used to treat cancer, multiple sclerosis, rheumatoid arthritis, and other conditions.
Our experts are proud to provide significant support to this report and are honored to be part of the collaboration with MAPRx. To learn more and to download the report, please visit MAPRx's site at http://maprx.info/15YearReport/
In addition to releasing the report, MAPRx is convening policymakers, health care experts, and patient advocates to participate in a half-day event, tomorrow, September 18, in Washington, D.C. to discuss the challenges facing this critical program and solutions to strengthen Part D for current and future beneficiaries. To learn more about this event, visit maprx.info/summit.