The Inflation Reduction Act’s redesign of Part D has raised out-of-pocket costs for many seniors, undercutting its original promise of affordability and access. Some Medicare beneficiaries have seen increased out-of-pocket costs as high as 32 percent. For patients managing chronic conditions, especially cardiovascular diseases, the gap between policy goals and lived reality is widening.
As costs climb, many seniors are being priced out of the treatments they need. The Centers for Medicare and Medicaid Services must ensure savings created by law are passed on to patients.
Middlemen Raising the Bill
Four of the nation’s largest pharmacy benefit managers who process 90% of all prescription claims have raised prices across nearly all categories of medicines. This includes generic drugs and those already subject to government price setting. For patients, this means that lower list prices negotiated through Medicare have not translated into lower costs at the pharmacy counter. Despite the policy intent of increased affordability, pharmacy benefit managers determine how much of the negotiated savings flow back to consumers.
Heart patients are most affected by these changes. Half of the medications chosen for negotiation in 2023–2024 target cardiovascular disease, a leading cause of death among Medicare beneficiaries. Without reforms to increase transparency and accountability, vulnerable patients remain exposed to sudden high costs, and could be forced to make dangerous choices to delay care if they are unable to afford treatment.
A Path Toward Patient-Centered Savings
Medicare Part D is meant to provide stable and affordable access to essential medicines. When beneficiaries face higher bills despite government negotiations, the system is not working as designed. Ensuring that savings reach patients requires more than price controls; reforms must address the tactics pharmacy benefit managers and insurers use to shift costs onto consumers.
Without stronger oversight, reforms intended to protect seniors risk doing the opposite. Stronger oversight and patient-centered policies are needed to ensure that Medicare Part D fulfills its promise of access, affordability and protection against catastrophic costs.
To learn more about the impact of Medicare price negotiations and how smart reform can protect patients, visit the Partnership to Advance Cardiovascular Health (PACH) website.
