By Marilyn Tavenner, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS)
Back in December, I heard about Lois, a senior citizen in Nebraska, who had reached the “donut hole” (coverage gap) in her Part D prescription coverage. Like many people her age, Lois was managing several chronic health conditions – high blood pressure, heart disease, and the recent onset of diabetes. She was staying healthy and active with the help of a regimen of prescription medicines, but the costs were adding up. Faced with paying all of those costs on her own in the coverage gap, Lois was starting to worry about making ends meet.
Fortunately, Lois received a happy surprise at her pharmacy when she showed up to pay that first bill in the gap – the total was much lower than she expected. In fact, her brand-name drugs had been discounted 50% and her low cost generic medications were more affordable as well.
Lois directly benefitted from the increasing discounts that many seniors enjoy in the coverage gap, a result of the Affordable Care Act. Those discounts, combined with savings from switching to a new Part D drug plan in 2012 that offered her better coverage, will help Lois save thousands of dollars on her drug costs this year.
With the gradual closing of the coverage gap, the Affordable Care Act is making Medicare drug coverage more affordable for Lois and many other people with Medicare. The coverage gap is that stage in Part D prescription coverage that starts when you and your drug plan have spent a certain amount of money for covered drugs and stops if you need catastrophic coverage. Catastrophic coverage kicks in if you pay $4,700 in 2012 for out-of-pocket drug costs (your plan will cover most of your drug costs above that amount). Another plus—the discounts you receive on brand-name drugs count as out-of-pocket drug costs, helping you get out of the coverage gap.
And there’s more to come because of the health care law. People with Medicare will get greater savings each year until the coverage gap is closed in 2020. Next year, for example, you’ll save 52.5% on brand- name drugs and 21% on generic drugs in the gap. By 2020, you’ll save 75% on brand- name drugs and 75% on generic drugs when you’re in the coverage gap.
As we celebrate the two-year anniversary of the health care law, we also celebrate the fact that these savings can be huge: over 5.1 million people with Medicare saved more than $3.2 billion on their prescriptions in 2010 and 2011—that’s an average of about $635 per person. For most people I talk to, these savings aren’t pocket change – they are meaningful. Just ask Lois.
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