Trump Administration Drug Pricing Proposals May Actually Raise Out-of-Pocket Costs for People with Medicare

Last week, the Medicare Rights Center submitted comments on a Request for Information (RFI) from the Department of Health and Human Services (HHS). This RFI asked for feedback on a host of potential changes touted as ways to lower prescription drug costs for people with Medicare and Medicaid.

In May, the Trump Administration released a “blueprint” of various proposals in an attempt to bring down drug costs. Medicare Rights supports efforts to make prescription drugs more affordable. Many people with Medicare struggle to afford their medications, and Medicare affordability is one of the top issues on our national helpline every year. Something must be done to ensure the millions of people with Medicare have access to needed prescriptions.

We were disappointed, however, to discover that this expansive RFI covered dozens of topics, but failed to introduce ideas to address the fundamental issue of high prices set by drug manufacturers. Instead, most of the proposals in the RFI involve merely shifting costs from one party to another. We fear that the ultimate impact of this set of ideas would result in, at best, no direct improvement for beneficiaries. At worst, they could cause sharp increases in out-of-pocket costs.

One proposal we can support would be the establishment of an out-of-pocket maximum for people with Medicare Part D. Part D should have a cap that reduces the incredible financial burden on those who have the highest drug costs. However, we have concerns that the Administration would only pursue such a cap if it could also pursue damaging changes that would increase the burden on people with Medicare such as extending the time those with high drug costs spend in the so-called “donut hole,” where their coverage is less robust.

In addition, HHS proposes lessening the number of drugs people with Medicare would have access to and potentially sharply increasing the cost for some drugs by changing coverage rules. Such changes seem to be heading in exactly the wrong direction to ensure beneficiaries have access to needed medications.

While there are some ideas in the RFI that Medicare Rights supports, the Administration should reconsider the problem of drug pricing and introduce a more robust set of proposals that would get at the fundamental issues of unaffordable medications. Simply shifting sky-high costs around and allowing people with Medicare to fall further and further behind is not a solution at all.

Read our comments.

Read more about the RFI.

Read the RFI.