Lawmakers seek relief for chronically ill seniors

Rep. Johnson leads legislative effort to make high-cost drugs affordable

WASHINGTON, D.C. 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, is spearheaded by Sens. Bill Nelson (D-FL) and Susan Collins (R-ME) in the Senate and U.S. Reps. Hank Johnson (D-GA) and Walter Jones (R-NC) 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.

“How can we look our seniors in the eye – people suffering from leukemia, Crohn’s disease or multiple sclerosis – who are required to pay more in prescriptions than they bring home each month – and say ‘sorry, you’re out of luck. It’s either food on the table and roof over your head or the life-saving drugs – you can’t have both,’ ” said Rep. Johnson.

“This change could help thousands of seniors afford their needed medications, saving them hundreds of dollars over time,” said Sen. Nelson, who chairs the Senate Special Committee on Aging. “They should not be forced to choose between treating their ailments or meeting other basic needs.”

More than 30 national groups support the bill, including: The National Council on Aging, MAPRx Coalition, National Health Council, National Multiple Sclerosis Society, National Hemophilia Foundation, The Lupus Foundation of America, The AIDS Institute, National Kidney Foundation, National Organization for Rare Disorders, United Cerebral Palsy, National Osteoporosis Foundation, Parkinson’s Action Network, Arthritis Foundation, Alzheimer’s Association, Epilepsy Foundation, American Academy of Physician Assistants, Asthma and Allergy Foundation of America, Mental Health America and Atlanta Area Agency on Aging.

###