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O’Halleran Hopes to See Lower Senior Prescription Costs

O’Halleran Hopes to See Lower Senior Prescription Costs
November 03
05:41 2021

O’Halleran Applauds Prescription Drug Pricing Provision in Proposed Build Back Better Bill

Cong. Tom O’Halleran

(11/2/21) WASHINGTON – Today, following news that agreement had been reached on a proposed plan to lower prescription drug costs for seniors in the developing Build Back Better legislative package by capping seniors’ out-of-pocket costs and giving Medicare the power to negotiate lower drug prices, Congressman Tom O’Halleran (AZ-01) released the following statement:

“Arizona is home to over 1.35 million Medicare beneficiaries, many of whom often live on a fixed income, the median of which is only slightly over $29,000. The ever-rising costs of prescriptions drugs too often force these seniors to make the decision between life-saving health care or putting food on the table. I am extremely pleased to see a deal reached on a legislative solution to the skyrocketing costs for seniors within the evolving Build Back Better plan, and was proud to see the legislative framework of a measure I introduced in 2018 used as the vehicle for capping out-of-pocket-expenses for seniors. I am pleased that an initiative I have championed since my first term is finally moving forward and I look forward to seeing this in the final text of the bill.”

In the 115th Congress, O’Halleran introduced the Capped Allowable Payments from Seniors (CAPS) for Prescriptions Act, to limit the out-of-pocket costs seniors on Medicare pay for their prescription drugs. Under the CAPS for Prescriptions Act, annual out-of-pocket costs for drug payments, including deductibles, coinsurance, co-pays, and other uncovered costs for Medicare beneficiaries would be capped at $2,600.

According to AARP data, a single brand-name medication taken on a scheduled, repeating basis, was more than $6,600 a month in 2020. Older Americans take, on average, 4.7 prescription drugs every month.

Today’s agreed-upon proposal would

  • Cap out-of-pocket costs for all seniors to $2,000 per year and allow seniors to pay their out-of-pocket expenses throughout the calendar year via monthly installments instead of all at once;
  • Penalize drug manufacturers that raise the price of a drug beyond the inflation rate for drugs in Medicare Parts B and D beginning Oct. 1, 2021;
    • This inflation cap also applies to private insurance markets;
  • Increase transparency by establishing reporting requirements for Pharmacy Benefits Managers (PBMs) – the corporate middlemen between drug manufacturers and payors – so private plans know the true cost of drugs and price concessions can be passed on to consumers; and
  • Promote lower-cost options, such as generics, by incentivizing and bolstering competition in the marketplace.


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