Over 5 million Medicare beneficiaries in the United States struggle to afford prescription drugs, according to a new report from the U.S. Department of Health and Human Services — the same federal agency, broadly speaking, that administers Medicare.
Medicare in the United States — the federal public health insurance program for adults ages 65 and older, and well as many younger adults with certain health conditions — is administered by the Centers for Medicare and Medicaid Services (CMS), which is an arm of the Department of Health and Human Services (HHS). While CMS is narrowly concerned with administering Medicare and Medicaid (the joint federal-state insurance program for low-income people), there are divisions of HHS that study health policy and make recommendations regarding federal policy changes — including the Office of Health Policy, which issued the latest report,. These kinds of reports are often intended to inform Congress and the president of the potential need for new laws or changes to existing regulations.
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Many Medicare beneficiaries having trouble paying for prescription drugs
The new report shows that based on data from the National Health Interview Survey, an estimated 3.5 million adults ages 65 and older (6.6% of this age group) and an estimated 1.8 million adults under age 65 (22.7% of this age group) — all of them Medicare beneficiaries — had trouble paying for prescription drugs in 2019, the last year for which data was available. What’s more, certain groups were far more likely than others to report having problems paying for their drugs. One such group is Medicare beneficiaries under age 65, who typically qualify for Medicare because they have a disability or end-stage kidney disease. Among older adults, Black and Latino beneficiaries were about 1.5 to two times as likely as white beneficiaries to report having trouble paying for prescription drugs.
Not surprisingly, people with chronic health conditions — including those with diabetes — were more likely than other Medicare beneficiaries to have trouble paying for prescription drugs. Among people with diabetes, 9.9% of those ages 65 and older and 26.2% of those under age 65 experienced this problem — slightly higher than the numbers for all beneficiaries in these age groups. What’s more, among people with diabetes, 7.2% of those ages 65 and older and 22.0% of those under age 65 reported specifically not filling a prescription due to its cost.
“Our findings indicate substantial disparities in access to needed medications among Medicare beneficiaries,” the report authors concluded. Potential approaches to making drugs more affordable to Medicare beneficiaries, they wrote, include “direct price negotiations to reduce the cost of expensive medications, limitations on price increases over time, changes to the Medicare Part D benefit to reduce patient cost-sharing and cap beneficiaries’ out-of-pocket spending, and applying Part D pharmacy price concessions at the point of sale.” All of these changes would require an act of Congress to take effect — but if Congress did take action, “such changes would likely improve equitable access to prescription drugs and help improve medication affordability for millions of Medicare beneficiaries,” the authors concluded.
Want to learn more about saving on your diabetes care? Read “Save Money on Medicines,” “How Your Healthcare Team Can Help You Save on Medications” and “Do’s and Don’t’s for Saving Money With Diabetes.”