SOURCE: Lupus Foundation of America

September 12, 2016 14:32 ET

Study Finds MedPAC Proposal Redistributes Costs Among Beneficiaries

New Avalere Health Report Finds Out-of-Pocket Costs Will Increase for 1.1 Million Medicare Beneficiaries

WASHINGTON, DC--(Marketwired - September 12, 2016) - Today, Avalere Health released a new report, supported by the MAPRx Coalition, which found that recently proposed changes to Medicare Part D by the Medicare Payment Advisory Commission (MedPAC) would redistribute costs among beneficiaries by increasing out-of-pocket costs for 1.1 million beneficiaries while decreasing costs for approximately 100,000.

"While we support protecting beneficiaries by implementing an out-of-pocket cap, it is unacceptable to do so at the expense of other beneficiaries," said Bonnie Hogue Duffy convener of the MAPRx Coalition. "This proposal will create winners and losers among beneficiaries, undermining the Part D program's success. More than half of all Medicare beneficiaries, approximately 39 million people have come to rely on Medicare Part D for necessary, life-saving prescription medications."

The study analyzed the impact of two recommendations in MedPAC's June Report to Congress. The first would exclude the manufacturer coverage gap discounts for brand drugs from the calculation of a Medicare beneficiary's true-out-of-pocket (TrOOP) costs. Currently, the calculation of beneficiary spending while they are in the coverage gap, or donut hole, includes discounts they receive from pharmaceutical manufacturers. Under the proposal, these discounts would not apply, and beneficiaries would be required to spend more to reach the catastrophic level of Part D coverage.

The second proposed change would implement an out-of-pocket cap in Part D. Presently, beneficiaries are responsible for five percent of their total drug costs after reaching catastrophic coverage under Part D. The change would eliminate all beneficiary cost sharing for prescription medications in the catastrophic coverage phase.

"Taken together, MedPAC's proposed changes would undermine the relief of an out-of-pocket cap by increasing costs to five times more beneficiaries than it helps," said Duffy. "Congress should not undermine the closing of the coverage gap by forcing beneficiaries to remain there longer. MAPRx urges Congress to seek another path forward to give Medicare beneficiaries an out-of-pocket cap without causing undue harm to more than 1 million people with chronic diseases and conditions."

To read the full report, visit the MAPRx website at

About MAPRx:

The MAPRx Coalition brings together beneficiary, family caregiver and health professional organizations committed to improving access to prescription medications and safeguarding the well-being of beneficiaries with chronic diseases and disabilities under the Medicare prescription drug benefit (Part D). Learn more at

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