The Catalyst

Medicare Monday: Protecting Beneficiaries Who Receive Extra Help

Posted by Allyson Funk on June 1, 2015 at 11:26 AM

MedMon_Catalyst_BannerWelcome back to #MedicareMonday where this week we’re talking about Medicare Part D’s Extra Help program.

The Extra Help Program—also known as Low-Income Subsidies (LIS)—is designed to help Medicare beneficiaries with limited incomes better afford needed medicines. The program helps about 11.5 million low-income Part D beneficiaries by waiving or lowering their premiums and deductible, and reducing their cost-sharing for individual prescriptions. Click here to see if you qualify.

Unfortunately, some are considering harmful changes to this important part of the Part D program by proposing to increase copays for brand medicines used by beneficiaries who receive Extra Help. However, this proposal is not necessary and could instead compromise access to care for this vulnerable population, reduce adherence to needed medicines and raise overall Medicare costs.

tn_MedMonIncreasing out-of-pocket costs for beneficiaries with limited incomes is a misguided policy proposal. Proponents of this idea say it is intended to increase use of generic medicines, however even MedPAC has noted that generic drug use among Part D enrollees – including beneficiaries receiving Extra Help – is already high. In fact, in 2012 more than 3 in 4 prescriptions filled by beneficiaries receiving Extra Help were for generics.

Higher copays for Extra Help beneficiaries could also limit patient and provider choice, forcing changes in prescribed treatment even if it is not medically appropriate. In many therapeutic classes, substitution between a brand name drug and a chemically different generic is not medically appropriate. Policies that put patients at risk by forcing them to take a medicine other than the one their physician prescribes may do more harm than good by reducing adherence, which could in turn lead to poor health outcomes and increase total health care spending.

Like other proposals we’ve discussed, this one is short-sighted and could hurt rather than help beneficiaries while altering the successful Medicare Part D program. As always, check back in with us at #MedicareMonday next week or subscribe to email updates here. Get Updates

Topics: adherence, Part D, Medicare, Medicare Monday

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