New Report Examines 15 Years of Medicare Part D


WASHINGTON, /PRNewswire/ -- A new report released today on Medicare Part D found the program is as popular and robust as ever, but faces challenges that could result in increased costs and limited access for millions of beneficiaries. The study, "Fifteen Years of Part D: Gaining Perspective on the Medicare Prescription Drug Benefit," was commissioned by Medicare Access for Patients Rx (MAPRx) to commemorate the 15th anniversary of Part D.

"This report confirms what many of us already know - over the past 15 years, Part D has been a tremendous success for millions of Americans who rely on it for their prescription drug coverage," said Sandra C. Raymond, CEO of the Lupus Foundation of America (LFA), which founded the MAPRx Coalition in 2005. "However, the study also makes it clear that Part D needs to be strengthened. Policymakers should work toward solutions that address out-of-pocket costs and access."

Enacted in 2003, Medicare Part D provides access to prescription drug coverage for America's seniors and people with disabilities, including those who suffer from rare or chronic diseases. Today, more than 44 million Medicare recipients - nearly one in eight Americans - benefit from this bipartisan achievement. Prior to its enactment, Medicare beneficiaries did not have access to a comprehensive prescription drug benefit.

Key highlights of the report include:

  • Without congressional action, Medicare Part D beneficiaries will experience an increase of $1,250 in out-of-pocket spending to reach the catastrophic coverage phase in 2020. This dramatic cost increase, known as the "out-of-pocket cliff," combined with other proposed policy changes, could devastate beneficiary access to needed medications. The report affirms that an "out-of-pocket cap would offer significant relief."
  • One factor driving high out-of-pocket costs is the actual drug price beneficiaries must pay at the point-of-sale, particularly in instances where a beneficiary faces a deductible or a coinsurance. In Part D, the price at the point-of-sale is based on the list price and does not account for any rebates or discounts that might reduce the overall price. Applying rebates "at the point-of-sale" would ensure that beneficiaries and the government could benefit from these lower costs.
  • The proliferation of specialty tiers, subject to significant coinsurance and excluded from cost-sharing exceptions, forces beneficiaries to pay a significant percentage of the medication's cost. For drugs covered on the specialty tiers, the coinsurance amounts can range anywhere from 25 percent to 33 percent, leaving beneficiaries paying thousands of dollars in out-of-pocket costs for drugs and biologics used to treat cancer, multiple sclerosis, rheumatoid arthritis, and other conditions.

Read the full report at

In addition to releasing the report, MAPRx is convening policymakers, health care experts, and patient advocates to participate in a half-day event on September 18 in Washington, D.C. to discuss the challenges facing this critical program and solutions to strengthen Part D for current and future beneficiaries. To learn more about this event, visit

About MAPRx

MAPRx is a coalition convened by the Lupus Foundation of America consisting of more than 55 patient, family caregiver, and health professional organizations committed to strengthening and protecting Medicare Part D.

About the Lupus Foundation of America

The Lupus Foundation of America is the only national force devoted to solving the mystery of lupus, one of the world's cruelest, most unpredictable and devastating diseases, while giving caring support to those who suffer from its brutal impact. Through a comprehensive program of research, education, and advocacy, we lead the fight to improve the quality of life for all people affected by lupus. Learn more about the Lupus Foundation of America at


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SOURCE Lupus Foundation of America; MAPRx


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