Expensive Specialty Drugs Are Forcing Seniors to Make Hard Choices
There is a growing problem with Medicare prescription drug coverage for seniors who take high-priced specialty drugs: There is no cap on how much they pay. Each prescription drug plan is structured a little differently, but people with very high drug costs almost inevitably enter what's called the "catastrophic" phase of coverage. Then, they pay 5 percent of the list price of their drug - no small sum in an age of $10,000-a-month cancer drugs or, in Diane Whitcraft's case, a more than $7,000-a-month Multiple Sclerosis therapy. The number of seniors who reach the catastrophic phase has almost doubled over a four-year period, to more than 1 million people in 2015, according to a new analysis by the Kaiser Family Foundation. That trend was driven in part by a new generation of high-priced hepatitis C drugs, but includes high out-of-pocket costs for people taking drugs for cancer, multiple sclerosis, schizophrenia, and HIV. The Affordable Care Act took steps to close the "doughnut hole," the coverage gap where seniors have been on the hook for more of their prescription drug costs. But for a growing number, the doughnut hole barely matters. Their first or second prescription fill of the year might get them out of it, plunging them into a bigger problem - a phase of coverage where there's no upper limit on how much they will pay.
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