Do Medicare Part D cost increases affect you?

Medicare.goc logoSome in Congress are exploring policies that would make certain medicines more expensive by increasing co-pays for people who qualify for subsidies under the Medicare Part D program. These so-called Low-Income Subsidy (LIS) beneficiaries often are managing multiple health issues. They are more likely to have a disability and may live with higher rates of functional and cognitive impairments.

To qualify for this program, an individual must have an income below 135% of the federal poverty level, which makes it highly unlikely that there is extra income to pay out-of-pocket costs. In many of the states, an individual who is eligible for both Medicare and Medicaid are, to qualify, below 100% of the federal poverty level. For these beneficiaries, even a minor increase in out of pocket responsibility could be the impetus to stop taking a medication or to skip doses of a medication to stretch the supply. Any of these results could easily lead to poorer health outcomes, which would only cost the program more in unnecessary medical care or even hospitalizations.

In what seems an interesting twist, there has also been a push for more creative and effective adherence programs. If adherence is the goal, an increase in out-of- pocket costs for the beneficiary seems more likely to lead to skipping doses or switching medications rather than better compliance with a medication plan.

Individuals who qualify for the LIS program are already pretty good at taking the generic form of medications. According to the Medicare Payment Advisory Commission, in 2011, 74 percent of prescriptions for these Part D enrollees were filled with generic drugs and that percentage is increasing. This is an already vulnerable population that needs better supports to adhere to medication plans, not more out-of-pocket expense to make that job even harder.


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  1. Linette Helmuth Says:

    Valuable discussion , I learned a lot from the facts , Does anyone know if my company could possibly grab a blank AO 239 form to fill out ?

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