Medicare prescription drug plans offer cost control for 1st time ever, helping thousands of seniors

ByJason Knowles and Ann Pistone via WLS logo
Thursday, September 15, 2022
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Medicare prescription drug plans will offer cost control for the first time ever next year, benefitting thousands of Illinois seniors.

CHICAGO (WLS) -- For the first time in history, there will be cost controls for prescription drugs through Medicare.

President Joe Biden's Inflation Reduction Act will soon reign in some drug prices covered under Medicare; prices that have increased faster than inflation.

"Close to 30 pills a day and right now, as of June, my out of pocket was like $7,000," said John Kapcia, of Island Lake.

Kapcia said he pays so much for his prescriptions that he's had to make difficult, and potentially dangerous, choices.

"I was looking at which were the most expensive drugs and cut them off for a month or two. I had to, because I couldn't afford them all, at one point," he said.

The sting of drug prices affects most seniors.

"Medicare beneficiaries spend about 20% of their medical costs on prescription drugs," said Garrett Boorojian, managing partner and chief developing officer at WaveCapital Partners, LLC.

Prices for those medications have nearly tripled in the U.S. compared to other countries that already have government oversight.

"For the first time ever, Medicare, the federal government will be able to negotiate with the drug companies, prescription drug prices," Boorojian said. "That will start with 10 drugs, and by 2029, we can see up to 60 drugs to be negotiated. It's protecting the consumers and elderly people under Medicare and Medicaid."

Half of all prescription drugs covered by Medicare increased in price faster than inflation from 2019 to 2020. But starting next year, drug makers who increase prices higher than the inflation rate will have to pay a penalty. The provision means a lot to Kapcia.

"When they do that, we know we're being looked after and that's telling the medicine companies that we're watching them," he said.

Also in 2023, insulin copays will be limited to $35.

In 2025, the cost a person on pays out of pocket for drugs thought Medicare, will be capped at $2,000.

"The cap on the medicine, is the best thing out of the whole thing," said Kapcia, adding it's much needed relief for him and other seniors. "Finally, they are listening to us. We're going in the right direction."

Those on Medicare will also have access to free vaccines. About 125,000 seniors in Illinois will benefit from the cost savings.

Click here to read the Illinois fact sheet on the Inflation Reduction Act and its effects on health care costs