Lawmakers Seek Relief for Chronically Ill Seniors

Press Release

A bipartisan group of lawmakers introduced legislation today to allow Medicare Part D beneficiaries to request lower co-pays for high-cost specialty drugs used to treat chronic illnesses.

The proposal, the Part D Beneficiary Appeals Fairness Act (H.R. 2624), is spearheaded by Sen. Bill Nelson (D-FL) and Susan Collins (R-ME) in the Senate (S. 1488) and U.S. Reps. Hank Johnson (D-GA) and Rep. David McKinley (R-WV) in the House.

The lawmakers' legislation was filed in response to the rapid rise of tiered prescription benefit plans that shift high-cost medications to a specialty category that requires Medicare Part D beneficiaries to pay a larger share of the drug's cost.

Insurers use the tiers to differentiate among generic, brand name and "non-preferred" brand name drugs. For medications costing more than $600, many insurers place those drugs on a specialty tier that requires patients to pay from 25 to 33 percent or more of the drug's total cost -- rather than a flat copayment rate. Currently, Medicare Part D beneficiaries are prohibited from seeking exemptions from their plans that could lower their cost-share for specialty drugs -- a basic right beneficiaries have throughout the rest of the program.

For many seniors on a fixed income, these life-saving drugs for everything from cancer to rheumatoid arthritis, lupus and multiple sclerosis can cost upwards of $1,700 per month. Seniors who can't afford the medication report they often go without treatment.

"Expecting chronically ill seniors --most of whom are on a low, fixed income -- to pay thousands of dollars of treatment for specialty drugs monthly is unrealistic and unfair," said Johnson. "It's as if we are telling our seniors: "you can either have food on the table or the life-saving drugs -- you can't have both,'" said Rep. Johnson.

"Patients whose drugs are on the specialty tier are already struggling to make ends meet to afford their complex care needs," said U.S. Sen. Bill Nelson (D-FL). "Extending this appeal right to them is only fair."

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