By Aaron Allen, The Seattle Medium
Congresswoman Suzan DelBene (D-WA) announced a significant new benefit for Medicare recipients that will cap out-of-pocket prescription drug costs at $2,000 annually under Medicare Part D. This policy, part of the Democrats’ 2022 Inflation Reduction Act, is expected to save over 340,000 Washington seniors an average of $413 per year, with broader implications for millions of Americans.
“One of the biggest expenses for seniors and their families is prescription costs, and Democrats are lowering the price they pay at the pharmacy counter,” DelBene said. “The new annual out-of-pocket drug price cap will save seniors hundreds of dollars a year. This new benefit builds on other cost-saving aspects of the Inflation Reduction Act, and I will continue to find ways to make life more affordable for everyday Americans.”
Medicare beneficiaries will not need to take any action to receive this benefit, according to the plan. The new measure also includes an option to spread the cost of prescriptions throughout the year via a payment plan, avoiding large upfront expenses that typically occur early in the calendar year.
The $2,000 annual cap joins other cost-saving measures under the Inflation Reduction Act, including free vaccines, a $35 per month cap on insulin costs, and the ability for Medicare to negotiate certain drug prices directly.
“Nearly 56 million adults in the U.S. have a plan under Medicare that helps cover the cost of outpatient prescription medications, the kind you get from a pharmacy and take at home. And for the most part, satisfaction with this program, known as Part D, remains high,” according to the Medicare Payment Policy 2024 report to Congress.
Historically, Medicare Part D plans have lacked a limit on out-of-pocket spending, often leaving seniors financially vulnerable. A study by AARP found that many older adults have struggled with rising medication costs, with some resorting to skipping doses or forgoing their prescriptions entirely due to the expense.
“It is critically important that we address the expenses that seniors and their families are facing, and one of the biggest expenses is prescription drug costs,” DelBene said.
Before the Inflation Reduction Act, seniors prescribed costly medications could face annual expenses exceeding $10,000. For some, co-pays alone were unaffordable, jeopardizing their access to lifesaving treatments. DelBene highlighted how the new cap represents a monumental shift.
“Now, as of January 1 of this year, their out-of-pocket costs will be capped at $2,000 annually,” she said. “So that’s a huge change, a huge saving for seniors, and also making sure that people are getting the prescription drugs that they need.”
The annual cap is designed to be permanent unless Congress enacts changes in the future. The provision applies to all prescription drugs covered under Medicare Part D, with millions of Americans expected to benefit from the reform.
“This is current policy, so this goes forward and will stay this way unless Congress takes action to change it,” DelBene said. “This $2,000 cap cuts across all different prescription drugs that a patient might be taking. Nineteen million Americans are expected to save an average of about $400 each as a result of this each year. And there’s 340,000 Washington seniors who are going to benefit from this new benefit also.”
“And I just want to add this is on top of the $35 cap on insulin that was already in place,” she said.
President Joe Biden and Democrats have touted the Inflation Reduction Act as a landmark effort to make health care and other essential services more affordable for Americans. DelBene expressed optimism about the law’s impact on seniors in the Puget Sound region and beyond.
“This is all part of the Inflation Reduction Act that I supported,” DelBene said. “It takes a little while for policy getting passed to be put into place, to have an impact on families across the country, and so this benefit now is in place. It’s going to have a huge impact for seniors in Washington state, but all across the country.
“I think it’s incredibly important for people to be aware that it’s there, and I look forward to hearing from folks about the impact it’s having on families in our region and the savings that they’re seeing and the affordability of health care for our seniors.”
