Capping Out of Pocket Drug Costs for Seniors with No Premium Increase Key to Any Drug Pricing Legislation

WASHINGTON, DC (April 30, 2019): The Council for Affordable Health Coverage (CAHC)  – a coalition of employers, insurers, life science companies, PBMs, brokers, agents, patient groups, and physician organizations – weighed in ahead of today's Energy and Commerce Health Subcommittee's hearing on prescription drug coverage in Medicare.

The hearing will consider both Medicare Part B and Part D drug spending and is set to begin at 10:30 AM ET. CAHC President Joel White released the following statement:

"CAHC applauds the subcommittee's attention to improving prescription drug affordability and access for Medicare beneficiaries. This has been a years-long focus of our diverse membership, and we have developed common sense, consensus-based solutions that are ripe for Congressional action."

"Key to any drug pricing legislation must be the establishment of a budget neutral out-of-pocket cap for beneficiaries in Medicare Part D. Most private insurers limit the out-of-pocket expenses that consumers rack up in a given year and it is past time Medicare took a page from their book and offered these same protections. Importantly, we can achieve this objective without triggering premium increases for seniors. Next week, CAHC will host a Congressional briefing that explains how." 

CAHC will unveil its blueprint for market-based prescription drug affordability solutions at a Congressional briefing on Friday, May 10th at 1 PM ET in 2045 Rayburn House Office Building. The coalition's proposed measures include:

Improve Coverage and Lower Costs: Establish a budget neutral out-of-pocket cap for beneficiaries in Medicare Part D, implemented in a way to protect enrollees from premium increases.

Encourage Value-Based Payment: Reform pricing models and government barriers that inhibit value-based arrangements for prescription drugs in federal programs.

Increase Transparency: Require real-time prescription benefit tools, inclusive of patient and drug specific information, within a prescriber’s e-prescribing/EHR to fully inform the prescriber and patient of drug coverage and cost options before a prescription is written.