Senators introduce bill to lower prescription costs for seniors with chronic illnesses

Sens. Tom Carper (D-Del.) and Bill Cassidy (R-La.) on Wednesday introduced a bill that would allow people enrolled in the Program of All-Inclusive Care for the Elderly (PACE) to choose their prescription drug plan under Medicare Part D and save more in monthly medication costs.

PACE is a Medicare/Medicaid program that provides medical and social services through a team of health care professionals which enrollees have regular access to, with the aim of avoiding placement in a nursing home.

PACE enrollees are currently required to get their Medicare Part D-covered medications through the program. Joining another Medicare prescription drug plan means being unenrolled from PACE benefits.

Carper and Cassidy’s bill, the PACE Part D Choice Act, would allow PACE beneficiaries to enroll in stand-alone prescription drug plans not operated through the program. This would also make beneficiaries eligible for prescription drug plans subject to the $2,000 annual cap that was instituted by the Inflation Reduction Act earlier this year.

The legislation, if passed, would require that PACE inform beneficiaries of their options for prescription drug plans outside of the program and help facilitate enrollment.

“PACE participants in Delaware and across our nation are dealing with rising prescription drug costs every time they need a refill for their live-saving medications. It makes no sense that these older Americans cannot choose which Medicare Part D plan makes the most financial sense for them,” Carper said in a statement.

Cassidy, a physician, said the bill would ensure that PACE beneficiaries have the “same access to lower premiums and affordable prescription drugs that lead to better health outcomes as those in other Medicare programs.”

Under the current rules, PACE beneficiaries have an average monthly premium of $1,015.03, according to the lawmakers. The senators estimated their bill would save PACE participants an average of $972.03 a month on prescription drugs, resulting in an average monthly payment of $43.

The lawmakers are aiming to pass the bill during the current lame-duck session, with the legislation designed to go into effect beginning on Jan. 1, 2023.

The Carper-Cassidy bill isn’t the only legislation seeking to reduce prescription drug costs that is in play during the lame-duck session.

A bill introduced by Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) earlier this year aimed at reducing insulin costs could potentially move forward before the next Congress is sworn in next year.

Congress is also under pressure by medical groups to waive the 4 percent cut in Medicare payments to physicians that is scheduled to go into effect starting next year under the Statutory Pay-As-You-Go (PAYGO) Act of 2010, which requires that new legislation not increase projected deficits.

The PAYGO cut was suspended by Congress with the start of the COVID-19 pandemic, but this pause is set to expire beginning next year without additional action.