House Medicare Part D Reform Legislation


The National Health Council (NHC) appreciates this opportunity to provide feedback on the draft Medicare Part D reform legislation that the Ways & Means and Energy & Commerce Committees jointly released on May 23.

Founded in 1920, the NHC is the only organization that brings together all segments of the health community to provide a united voice for the more than 160 million people with chronic diseases and disabilities and their family caregivers. Made up of more than 125 diverse national health-related organizations and businesses, the NHC’s core membership includes the nation’s leading patient advocacy organizations, which control its governance and policy-making process. Other members include health-related associations and nonprofit organizations including the provider, research and family caregiver communities, and businesses representing biopharmaceutical, device, diagnostic, generic, and payer organizations.

The NHC is committed to ensuring patients have access to affordable, high-value medications. We share your concern that many Medicare beneficiaries currently struggle to afford their medications due to high out-of-pocket (OOP) costs, even when they are enrolled in a Part D plan. Some enrollees in Part D plans face many thousands of dollars in OOP costs for medications every year in addition to the OOP costs they may have for other health care services. Under existing law, Medicare Part D does not cap OOP costs for beneficiaries who are not eligible for the low-income subsidy (LIS) program.1 When non-subsidized Part D enrollees reach the catastrophic threshold, they continue to incur OOP expenses, in the form of five percent coinsurance, for the rest of the benefit year.

For these reasons, the NHC has long supported a cap on OOP costs in Medicare Part D. We are pleased that this issue has attracted increased attention in recent years, and we have documented our support for Congressional action to address this matter as recently as this past April.2 We also support the Committees’ proposal to realign incentives related to spending in the catastrophic phase.

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