Wyden Proposes Cap on Prescription Drug Costs


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Senate Finance Committee Ranking Member Ron Wyden, D-Ore., today introduced a bill to protect seniors in Medicare from high out-of-pocket costs in Part D plans. The bill, called the “Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2016” (RxCAP), would eliminate all cost-sharing for beneficiaries above the current out-of-pocket threshold of about $7,500.

U.S. Department of Finance

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WASHINGTON – Senate Finance Committee Ranking Member Ron Wyden, D-Ore., today introduced a bill to protect seniors in Medicare from high out-of-pocket costs in Part D plans. The bill, called the “Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2016” (RxCAP), would eliminate all cost-sharing for beneficiaries above the current out-of-pocket threshold of about $7,500.

“Escalating drug prices are increasingly straining the budgets of families in Oregon and across the country, particularly seniors in Medicare who often have to take multiple costly medications to stay healthy,” Wyden said. “It defies common sense that protection from high out-of-pocket costs exists for almost all other types of health coverage, but not for traditional Medicare.”

Because of the Affordable Care Act, which Wyden helped author, an out-of-pocket cap already exists for many commercial health insurance plans. But in 2013, 2.9 million people in Medicare Part D surpassed the out-of-pocket threshold of about $7,500. Those with the highest drug costs paid an average of $2,596 out-of-pocket per year above the threshold. Wyden’s bill would eliminate these costs for Part D enrollees.

Prescription drug spending has increased substantially in recent years, up 11.4 percent in 2014 and 6.8 percent in 2015. These increases have led to an higher out-of-pocket costs for many, which strains fixed budgets and makes it more likely patients will skip doses or stop taking their medication altogether.

Co-sponsors of this legislation include Sens. Ben Cardin, D-Md., Michael Bennet, D-Colo., and Maria Cantwell, D-Wash.

Legislative text of the bill can be found here.

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