There’s a growing problem with Medicare prescription drug coverage for seniors who take high-priced specialty drugs: there’s no cap on how much they pay.
As The Denver Post reports, 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, which is no small sum in an age of $10,000-a-month cancer drugs
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. A trend driven in part by 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 coverage gap where seniors have been on the hook for more of their prescription drug costs but a growing number of seniors, are falling into another problem – a phase of coverage where there is no upper limit on how much they will pay.
