Re­port on facts about Medi­care Part D

Daily Local News (West Chester, PA) - - FIFTY PLUS - Kath­leen Martin Le­gal Ease

Medi­care ben­e­fi­cia­ries have had ac­cess to Medi­care Part D for 10 years now, as Part D joined Medi­care Parts A, B and C in 2006. Prior to that, there was no pre­scrip­tion drug ben­e­fit for Medi­care ben­e­fi­cia­ries other than dur­ing a hospi­tal stay (Medi­care Part A), some med­i­ca­tions ad­min­is­tered in the doc­tor’s of­fices (Part B) or for some drugs un­der the hos­pice ben­e­fit. Al­though there have been many complaints about the per­ceived in­ad­e­quacy of this ben­e­fit (par­tic­u­larly the cov­er­age gap or donut hole), over­all it has sig­nif­i­cantly aided many Medi­care ben­e­fi­cia­ries with be­ing able to af­ford their pre­scrip­tion med­i­ca­tions. The Kaiser Fam­ily Foun­da­tion (KFF) has re­cently pub­lished “10 Es­sen­tial Facts about Medi­care and Pre­scrip­tion Drug Spend­ing.” (http://kff.org/ in­fo­graphic/10-es­sen­tial­facts-about-medi­care-and­pre­scrip­tion-drug-spend­ing/).

The Kaiser Fam­ily Foun­da­tion ac­knowl­edges that pre­scrip­tion drugs play an im­por­tant role in health­care for 57 mil­lion se­niors and per­sons with dis­abil­i­ties. The Medi­care Boards of Trustees pre­dict that the per capita spend­ing will in­crease even more in the next decade as more high­priced spe­cialty drugs be­come avail­able. Nev­er­the­less, some ben­e­fi­cia­ries can still face sub­stan­tial out-of­pocket costs, es­pe­cially if the ben­e­fi­ciary takes mul­ti­ple high-cost brand-name drugs or spe­cialty drugs.

The KFF re­port lists the fol­low­ing facts in part:

• Medi­care ac­counts for a grow­ing share of the na­tion’s pre­scrip­tion drug spend­ing: 29 per­cent in 2014 as com­pared to 18 per­cent in 2006;

• Pre­scrip­tion drugs ac­counted for $97 bil­lion in Medi­care spend­ing in 2014, nearly 16 per­cent of all Medi­care spend­ing in that year;

• Medi­care Part D pre­scrip­tion drug spend­ing — both to­tal and per capita — is pro­jected to grow more rapidly in the next decade than it did in the pre­vi­ous decade;

• Part D spend­ing has in­creased in re­cent years, in part due to the in­tro­duc­tion of new, costly break­through treat­ments for Hep­ati­tis C;

• Medi­care per ben­e­fi­ciary spend­ing is pro­jected to grow more rapidly for the Part D pre­scrip­tion drug ben­e­fit than for other Medi­care-cov­ered ser­vices over the next decade;

• Pre­scrip­tion drugs ac­counted for nearly $1 in ev­ery $5 that Medi­care ben­e­fi­cia­ries spend out-of-pocket on health care ser­vices in 2011, not in­clud­ing pre­mi­ums;

• The ex­pected in­crease in Part D spend­ing will mean hun­dreds of dol­lars more in higher an­nual pre­mi­ums and de­ductibles for ben­e­fi­cia­ries over the com­ing decade;

• As a re­sult of the Af­ford­able Care Act (ACA or Obama Care), Medi­care ben­e­fi­cia­ries are now pay­ing less than the full cost of their drugs when they reach the cov­er­age gap (aka “the donut hole”) and will pay only 25 per­cent for both brand-name and generic drugs.

High (and ris­ing) drug costs are a con­cern for the pub­lic, and many pro­pos­als of­fer­ing ways to re­duce costs for all ben­e­fi­cia­ries en­joy broad sup­port. The ac­tual re­port has many charts and graphs which help ex­plain the es­sen­tial facts in the re­port. Keep­ing our­selves in­formed and sup­port­ing pro­pos­als to re­duce costs are im­por­tant for all of us.

The le­gal ad­vice in this col­umn is general in na­ture, Con­sult your at­tor­ney for ad­vice to fit your par­tic­u­lar sit­u­a­tion.

Kath­leen Martin, Esquire is li­censed to prac­tice in the Com­mon­wealth of Penn­syl­va­nia and is cer­ti­fied as an Elder Law At­tor­ney by the Na­tional Elder Law Foun­da­tion as au­tho­rized by the Penn­syl­va­nia Supreme Court. She is a prin­ci­pal of the law firm of O’Don­nell, Weiss & Mat­tei, P.C., 41 High Street, Pottstown, and 347 Bridge Street, Phoenixville,610-323-2800, www. owm­law.com. You can reach Mrs. Martin at kmartin@owm­law.com

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