A new law could make some prescription drugs more affordable, particularly for people with Medicare Part D drug coverage.
Under the Inflation Reduction Act enacted last year, Medicare Part D beneficiaries could have lower out-of-pocket costs for prescription drugs this year. The legislation is significant for the pulmonary hypertension community because of the high cost of treatments for complex pulmonary conditions.
One of the most significant changes this year is an out-of-pocket spending cap on some prescription drugs. When patient spending reaches $8,000, known as the catastrophic coverage phase, they no longer have to pay a 5% copay for prescriptions covered under Part D.
The $8,000 catastrophic threshold includes the amount Part D enrollees spend out of pocket plus the value of certain payments made on behalf of the patient, including Medicare’s Extra Help program and manufacturer price discounts. Many people with PH reach the catastrophic threshold by February of each year.
Previously, beneficiaries paid a 5% copay when their drug spending reached the catastrophic phase. There was no limit on how much beneficiaries paid for coinsurance, which made many high-cost medications unaffordable.
Another key change is that all Part D beneficiaries who qualify for Medicare Extra Help (low income subsidy) will be eligible for full subsidies. That means they will have no premiums, no deductibles and lower coinsurance for brand and generic drugs.
The change applies to Part D beneficiaries who earn less than 150% of the federal poverty level. The income threshold previously was 135%. The change will make medications more affordable and accessible for eligible Medicare beneficiaries.
