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Lower Out-of-pocket Costs and Improved Access to Medicines are Critical Steps in a Better Direction for Medicare

PFCD applauds efforts to support the fight against costly chronic disease with rebate reforms
February 1, 2019 (WASHINGTON, D.C) The Partnership to Fight Chronic Disease (PFCD) shared the following statement commending the access improvements in the Administration’s rebate proposal:
More than 80 percent of Americans 65 and older have one chronic condition, and nearly four in ten Medicare beneficiaries have at least four chronic conditions. Prescription medicines are an essential piece of the healthcare plan for the treatment and management of chronic conditions, particularly for older Americans, and accordingly, annual prescription drug use increases with the number of chronic conditions.  People with three to four chronic conditions, for example, fill an average of 24 prescriptions a year.  People with five or more conditions fill 51 prescriptions on average[1]. Improving health outcomes and ultimately lowering costs throughout the U.S. healthcare system is an opportunity in Medicare that cannot be overlooked.
Out-of-pocket costs continue to be a problem for many beneficiaries, particularly as more and more costs are being shifted to them through the increased use of coinsurance instead of flat copayments for medicines[2] and growth of serious chronic conditions among the beneficiary population. From 2015 to 2018, the share of drugs subject to coinsurance jumped almost 20 percentage points[3].
Reducing beneficiaries’ out-of-pocket costs for medicines can lower Medicare costs in other areas. Sharing a portion of rebates and discounts with the beneficiary at the point-of-sale would immediately lower costs for millions of beneficiaries, improve adherence to therapy, and could reduce government spending on hospital and physician services.
With an important goal of lowering out-of-pocket costs while providing prescribed medications, it should be of the highest importance to keep focus on the quality and outcomes of a comprehensive care plan for patients managing chronic conditions. Creating medication intervals with cost or coverage gaps could interrupt and cause for unintended consequences due to lapses in prescribed treatment, and the potential for total costs to elevate is more than considerable. The rebate policy proposal would prevent that and enable beneficiaries to share any savings from rebates at the pharmacy counter. The Administration’s proposal would support access to prescribed medications that are relied on by millions of America’s most vulnerable healthcare consumers.
The Partnership to Fight Chronic Disease (PFCD) is an internationally-recognized organization of patients, providers, community organizations, business and labor groups, and health policy experts committed to raising awareness of the number one cause of death, disability, and rising health care costs: chronic disease. 

[1] Buttorff, C. Ruder T., & Bauman M. Multiple Chronic Conditions in the United States. RAND Corporation. 2017. Accessed at

[2] Kaiser Family Foundation. An Overview of the Medicare Part D Prescription Drug Benefit. Oct. 12, 2018. Accessed at

[3] Avalere Health, 2018 Medicare Part D Formularies: An Initial Analysis. Nov. 2017.