Michigan Senate panel advances bill scraping third-grade reading law

Opinion: Lower out-of-pocket cost for seniors' prescriptions

Brianna Romines

Like most patients with serious health conditions, patients with epilepsy rely on effective and cutting-edge medicines to keep their diseases under control.

The good news is that prescription drugs help control seizures for about 7 out of 10 people living with epilepsy. The bad news is that for seniors and people with disabilities in Michigan who rely on Medicare Part D to cover their prescription drug costs, out-of-pocket costs could be going up by more than $1,200 per year before the end of 2020, unless Congress acts.

A prescription drug compromise that would lower costs for Medicare recipients has cleared a key hurdle in the Senate, but Republican resistance signals trouble when the legislation goes to the floor.

Many of these seniors and people with disabilities already struggle — and some are already unable — to afford the medicine they need. The number of those who will go without their important treatment could increase significantly without a meaningful cap on out-of-pocket costs.

Michigan’s senior U.S. senator, Debbie Stabenow, has long been a champion for local patients, approving a cap on out-of-pocket medicine costs for those who rely on Medicare’s prescription drug plan.

U.S. Sen. Debbie Stabenow speaks at the 2019 NAACP convention in Detroit, Monday.

From her seat on the powerful Senate Finance Committee, which this summer has been examining ways to limit out-of-pocket costs, Stabenow must push for further patient protections.

Late in July, the committee approved a bill that included a cap that didn’t go far enough. We need a new bill that has a lower cap, takes effect sooner and includes efforts to lower out-of-pocket costs.

Congress should also deflect high costs that people on Medicare face at the beginning of the year by smoothing prescription costs across the year.

Future changes in federal law and the expiration of a provision in the Affordable Care Act will result in seniors covered by Medicare Part D having to pay an additional $1,250 out-of-pocket annually for their prescriptions before qualifying for Medicare’s so-called catastrophic coverage, according to analysis by the Kaiser Family Foundation. 

The new spending threshold increase for 2019-20 could mean an additional 100 dollars per month out of senior's budgets just to take their medicine. For seniors living on a fixed income, an additional $100 per month in out-of-pocket health care costs could force our state’s older parents and grandparents to face spending decisions that they should never be forced to make — like decisions between medicine or utilities, rent or food.

Seniors who do not qualify for low-income subsidies under Medicare Part D could face even higher costs. A 2019 analysis of specialty medicine coverage for some of the world’s most challenging diseases found Part D enrollees facing out-of-pocket costs that exceeded $16,500 per year for a single medication.

Last month’s action from Stabenow’s committee was a good start, but we’re encouraging her and others to continue the fight. Seventy-six percent of voters support capping out-of-pocket prescription costs for Part D enrollees, according to the most recent polling.

At the Epilepsy Foundation, we are committed to policy reforms that put patients first, and ensure everyone who suffers from a seizure disorder has access to the lifesaving medicine he or she needs. We support a meaningful cap on out-of-pocket costs for seniors enrolled in Medicare Part D, along with reducing out of pocket costs under the cap and efforts to smooth month-to-month costs, and we hope Congress will stand with us.

Brianna Romines is the president of the Epilepsy Foundation of Michigan.