June 2021

Watch the Video Here

Washington, DC – Today, Protect Our Care is releasing a new video as part of Week 4 of the Lower Rx Summer Campaign that highlights how high drug prices impact women disproportionately. Throughout the week, Protect Our Care will host events and release additional research to demonstrate the urgency for reform to bring down drug prices for women, including allowing Medicare to negotiate drug prices for everyone. 

Earlier this week, Protect Our Care released a report showing that women are more likely than their male counterparts to use prescription drugs. Economic and social inequality leave women with lower pay and less wealth, making it harder to afford health care. Women are also more likely to be caregivers, leaving them responsible for purchasing medications for family members. As a result, women are more likely than men to skip needed prescriptions because of cost. This problem is only getting worse: A 2019 Gallup poll found that the gender gap for prescription drug affordability is growing, with 28 percent of women unable to afford a prescribed medication in the previous year, compared to 18 percent of men. 

Remaining Theme Weeks for Lower Rx Summer
Week 4 (June 28): How High Drug Prices Hurt Women
Week 5 (July 5): How High Drug Prices Hurt People with Disabilities
Week 6 (July 12): How High Drug Prices Hurt People of Color
Week 7 (July 19): How High Drug Prices Hurt Small Businesses
Week 8 (July 26): How High Drug Prices Hurt Children

“This video shows the impacts of Big Pharma’s greed, particularly for women who carry more of the burden from the high prices of prescription drugs,” said Protect Our Care Communications Director Anne Shoup. “Americans should not have to pay three times more for the same medicines as people in other countries, and unfortunately more women are finding themselves in the impossible position of choosing between paying for lifesaving drugs and paying for housing or food. As the nation recovers from the coronavirus pandemic, ensuring access to affordable health care and lowering the cost of prescription drugs has never been more critical for American women.”

Protect Our Care Releases New Report As Part of Lower Rx Summer

Washington, DC — Today, Protect Our Care is kicking off Week 4 of Lower Rx Summer with a report underscoring how high drug costs hurt women. Throughout the week, Protect Our Care will host events and release additional research to demonstrate the urgency for reform to bring down drug prices for women.

Remaining Theme Weeks for Lower Rx Summer

Week 4 (June 28): How High Drug Prices Hurt Women

Week 5 (July 5): How High Drug Prices Hurt People with Disabilities

Week 6 (July 12): How High Drug Prices Hurt People of Color

Week 7 (July 19): How High Drug Prices Hurt Small Businesses

Week 8 (July 26): How High Drug Prices Hurt Children

Women are more likely than their male counterparts to use prescription drugs. Economic and social inequality leave women with lower pay and less wealth, making it harder to afford health care. Women are also more likely to be caregivers, leaving them responsible for purchasing medications for family members. As a result, women are more likely than men to skip needed prescriptions because of cost. This problem is only getting worse: A 2019 Gallup poll found that the gender gap for prescription drug affordability is growing, with 28 percent of women unable to afford a prescribed medication in the previous year, compared to 18 percent of men. 

“It’s clear the current system is unjustifiable and unsustainable for all Americans, but particularly for women who carry more of the burden from the high prices of prescription drugs,” said Protect Our Care Communications Director Anne Shoup. “Americans should not have to pay three times more for the same medicines as people in other countries, and unfortunately more women are finding themselves in the possible position of choosing between paying for lifesaving drugs and paying for housing or food. It’s time to put an end to Big Pharma’s greed and give Medicare the power to negotiate for lower drug prices.”

In 2019, the House of Representatives passed the Lower Drug Costs Now Act (H.R. 3), historic legislation that would lower drug prices for all Americans. H.R. 3 would save patients over $150 billion and reduce the price of the costliest drugs by as much as 55 percent. 

Not only does giving Medicare the power to negotiate help patients at the pharmacy counter, but it would save the federal government $500 billion, which could be reinvested to strengthen health care. These savings could help lower premiums, expand coverage, and strengthen Medicare benefits to include hearing, vision, and dental. As the nation recovers from the coronavirus pandemic, ensuring access to affordable health care, and specifically prescription drugs, has never been more critical. 

KEY POINTS

• Gender disparities restrict prescription drug access. The gender pay gap leaves women with lower incomes and reduced ability to pay for needed medications. More than one in four women who take prescription drugs reported not filling a prescription due to cost. This inequity is compounded for women of color.

• Prescription drug use is more prevalent among women. More than half of women take prescription medication, making drug costs a regular stressor for millions. With age, medication use increases, disproportionately impacting women who live an average of five years longer than their male counterparts.

• Big Pharma’s price gouging disproportionately impacts women. Several of the highest grossing prescription drugs are used in the treatment of diseases that disproportionately impact women. 
• Drug pricing reform would benefit women. 80 percent of Americans understand drug prices are skyrocketing because of Big Pharma’s bottom line, with 75 percent stating they do not have confidence in drug manufacturers to set fair prices. 

Read the new report on How High Drug Costs Hurt Women here.

Washington, DC — The Biden administration announced that they are revoking permission for burdensome Medicaid work requirements in Arizona and Indiana, reversing one of the Trump administration’s most harmful policy initiatives. The D.C. Circuit Court of Appeals previously ruled that this cruel and ineffective policy is  “arbitrary and capricious” and fails to advance the purposes of Medicaid. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“These burdensome paperwork requirements approved by the Trump administration were meant to boot people off the rolls, which was particularly heartless during the dual public health and economic crises facing Americans. Rather than find ways to rip health care away from Americans during a pandemic, the Biden administration is making health care more affordable and leading the effort to fight the virus. In his short time in office, President Biden has delivered on his promises for the American people by rolling back the Trump administration’s sabotage of the ACA, opening a special enrollment period that has helped nearly one million Americans get covered, and passed the American Rescue Plan which lowers premiums and expands coverage to millions of Americans — a provision he pledged to make permanent.”

Protect Our Care Releases New Fact Sheet As Part of Lower Rx Summer

Protect Our Care is releasing a fact sheet outlining the costs and implications of Biogen’s new Alzheimer’s medication, Aducanumab, as part of Week 3 of Lower Rx Summer, which is focusing on how drug prices hurt seniors. These costs demonstrate the urgent need to empower Medicare to negotiate to bring down the cost of prescription drugs.

Americans already pay three times more for prescription drugs than our counterparts around the world. With the recent approval of Aducanumab, an exorbitantly expensive and unproven Alzheimer’s drug, intensified costs are expected to become a fixture of American health care spending for years to come. The drug’s $56,000 price tag and estimated $11,200 out-of-pocket cost will push Aducanumab out of reach for the vast majority of patients, as the total cost is nearly double the income of 50 percent of Medicare beneficiaries. While the costs of Aducanumab are extreme, they don’t stop with the medication. PET scans and MRIs, which are not covered by Medicare for Aducanumab treatment, play a crucial role in the drug’s use, creating additional out-of-pocket expenses. The treatment of millions of patients will increase premiums and cost-sharing requirements across the board, particularly for seniors on Medicare. No one should be forced to decide between treatment for a devastating disease and financial ruin. 

Biogen’s greed is appalling —profits over patients, families, and the nation’s health care system. The public understands that drug manufacturers like Biogen are exploiting a broken system that allows skyrocketing drug costs at the expense of all else. That is why the majority of Americans support giving Medicare the power to negotiate for lower drug prices. Requiring Big Pharma to play fair will save nearly $600 billion on prescription drug costs, which can be reinvested to strengthen health care for millions of Americans, including those with Alzheimer’s. These savings could establish an out-of-pocket cap for drug costs under Medicare and expand Medicare benefits to include hearing, vision, and dental.

KEY POINTS

• Biogen’s blatant greed is financially devastating to Alzheimer’s patients. Aducanumab, can provide no benefit to those suffering from Alzheimer’s if they cannot afford to access it. The drug’s $56,000 annual price creates out-of-pocket expenses so prohibitive, many will be unable to access the care they have been desperately waiting for. While Biogen enjoys soaring share prices, patients and their families will be forced to make the impossible choice between treatment and financial ruin.
• Medicare cannot withstand the cost of Aducanumab. The drug will have groundbreaking implications for patients, taxpayers, and the entirety of the American health care system. Even if just two of America’s six million Alzheimer’s patients began Aducanumab, it would cause Medicare spending alone to explode by $90 billion – all for a single, unproven drug. A spending increase on this scale would raise premiums across the country, with Medicare beneficiaries experiencing the greatest hardship.
• Seniors back bold action to reign in corporate profiteering and lower prescription drug prices. Americans know drug manufacturers are taking advantage of a broken system, with 80 percent identifying the pharmaceutical industry’s prioritization of profits as the reason for skyrocketing drug costs. The majority of seniors agree and 82 percent want the federal government to negotiate with Big Pharma to lower their prescription drug prices.

Biogen’s Blatant Greed Is Financially Devastating To Alzheimer’s Patients

Aducanumab’s Out-Of-Pocket Price Highlights Access Disparities For Seniors. The vast majority of Alzheimer’s patients are over 65, many relying on Medicare for health coverage. As an infusion drug, Aducanumab would be covered under Medicare Part B, which requires patients to pay 20 percent of the $56,000 per year price tag. $11,200 in annual out-of-pocket expenses for a single drug would easily push treatment out of reach for many, stressing the extreme disparities that exist for seniors attempting to access specialty drugs, particularly those who are low-income, people of color, and in poor health.

Biogen’s Price Gouging Preys On Vulnerable Patients. While Biogen offers inconclusive evidence of Aducanumab’s effectiveness, executives continue to insist the drug’s $56,000 price tag is ‘responsible’. For the millions of Alzheimer’s patients and their families, desperate for treatment options, Aducanumab’s cost is not responsible – it’s reprehensible. Half of Medicare recipients live on less than $29,650 per year. Even the Alzheimer’s Association called the price of the drug “simply unacceptable” and stressed the need for Biogen to reduce Aducanumab’s cost.

Biogen Stands To Make Billions As Seniors Struggle. Aducanumab is priced at a rate more than six times its estimated value. The Institute for Clinical and Economic Review has assessed that Aducanumab could only be cost-effective at a price under $8,300 per year. 

Aducanumab’s Price Puts Big Pharma’s Greed On Full Display. Even Wall Street analysts did not predict a pharmaceutical corporation would set such an outrageous price for an Alzheimer’s drug. On the day the F.D.A. announced Aducanumab’s approval, Biogen’s shares skyrocketed by 38 percent.

Medicare Cannot Withstand The Cost Of Aducanumab

Health Care Spending Would Surge. If only a third of Americans with Alzheimer’s receive Aducanumab, health care spending could increase annually by $112 billion. With the annual price set at $56,000, Medicare would be spending $90 billion on Aducanumab for two million patients and out-of-pocket spending for patients would be $22 billion for the drug alone. For context, Medicare Part D spent $90 billion in 2020, covering all of the prescription drugs of 46 million Americans. 

Cost-Sharing Requirements Would Skyrocket. Aducanumab’s astronomical price would expose the full brunt of Medicare’s cost-sharing requirements for the six million Medicare beneficiaries with no supplemental coverage. This cost sharing responsibility for Part B medications, like Aducanumab, will be particularly painful for the 90 percent of Medicare Advantage beneficiaries with plans requiring 20 percent coinsurance rates for in-network providers, with that figure surging to 50 percent for medications provided out-of-network. 

Aducanumab Will Increase Premiums For Seniors. Premiums for 56 million Medicare Part B beneficiaries will be heavily impacted by Aducanumab spending. Part B premiums are set equal to 25 percent of annual projected Part B expenditures. An escalation on the scale Aducanumab threatens would drastically alter yearly Part B spending, increasing the cost for all recipients.

Costs Extend Far Beyond The Drug Itself. While the costs of Aducanumab are extreme, the implications for Medicare don’t stop with the medication. PET scans and MRIs play a crucial role in the use of Aducanumab to both diagnose and monitor patients for potential serious side effects, such as brain swelling and bleeding. Medicare does not typically cover the costs of scans used to identify Alzheimer’s associated amyloid buildups and is being aggressively lobbied by scan manufacturers to cover imaging and at higher rates. The options are grim. Either press over-stretched patients to spend additional out-of-pocket dollars, or put pressure on an already overwhelmed Medicare budget to cover yet another Aducanumab related cost.

Aducanumab Is High Risk, High Uncertainty. Despite its high cost, there is no conclusive evidence that Aducanumab is an effective Alzheimer’s treatment, justifying the concern and confusion of FDA advisory committee members, doctors, and bio-pharma industry insiders. Not only has Biogen been unable to produce strong evidence of clinical benefit, despite its astronomical cost, Aducanumab has serious potential side effects. In two seperate clinic trials, 40 percent of patients experienced brain swelling and 17 percent experienced microhemorrhages. Only a broken system would allow the makers of an unproven drug to reap enormous profits from patients grappling with a devastating disease.

Seniors Back Bold Action To Lower Prescription Drug Prices

Seniors Support Federal Government Action To Lower Drug Costs. Nearly 70 percent of seniors want Congress to take action on drug prices by establishing an out-of-pocket limit for Medicare beneficiaries. 82 percent favor empowering the federal government to negotiate lower prescription drug prices, to protect against unconscionable launch prices like Aducanumab’s.

Americans Know Big Pharma Is Taking Advantage Of A Broken System. 75 percent of Americans don’t trust drug manufacturers to set reasonable prices for their drugs and eight in ten believe Big Pharma’s prioritization of profits is to blame for rising cost of prescription drugs.

Older Americans Want A Level Playing Field. Seniors have had enough of paying more for medications than their counterparts around the world. Legislative efforts by Democratic leaders would establish a ceiling price for all negotiated drugs by tying it to the average price in other countries and penalizing pharmaceutical corporations that don’t play by the rules. Six in ten Americans over 65 support tying what Medicare pays for prescription drugs to the amounts paid by other countries.

Washington, D.C. —  This week, the Wall Street Journal Editorial Board criticized Democrats for their “assault” on the cost of Biogen’s new Alzeheimer’s drug, Aduhelm. This comes after Biogen announced they would be charging $56,000 for a year’s worth of treatment — almost twice the median income of a Medicare beneficiary — for a drug experts say may not even work. Even the Alzheimer’s Association called the price of Aduhelm “simply unacceptable” and warned “this price will pose an insurmountable barrier to access, it complicates and jeopardizes sustainable access to this treatment, and may further deepen issues of health equity.” In response, Protect Our Care Chair Leslie Dach issued the following statement: 

“Everyone who has known someone with Alzheimer’s knows that this is a horrible, devastating disease. Biogen is feeding on the hopes of millions of Alzheimer’s patients and their families and taking advantage of a broken system that allows drugmakers to set outrageous prices without any limitations. You don’t help people with Alzheimer’s with a drug no one can afford. There is no one more committed to fighting for older Americans and no one who has fought harder to ensure Americans can afford their medications than Senate Finance Chairman Senator Ron Wyden. It’s plain and simple: the Wall Street Journal has repurposed PhRMA talking points while Democrats and Chairman Wyden are committed to ensuring Alzheimer’s patients can afford the treatments they need.” 

Call Demonstrated Urgent Need for a Federal Solution to Close the Coverage Gap and Extend Coverage to Millions

Watch the Event Here

Washington, DC — Today, U.S. House Majority Whip James E. Clyburn (D-SC-06) and U.S. Rep. Robin Kelly (D-IL-02) joined Protect Our Care for a press call advocating for a federal solution for closing the Medicaid coverage gap. Republican leaders in 12 states have rejected Medicaid expansion, blocking millions of people from access to coverage. Four million uninsured adults — including at least 2.4 million people of color, 500,000 people with disabilities and almost a million older Americans — could gain Medicaid coverage if the remaining states adopted Medicaid expansion. 

The call came after leaders of the Congressional Tri-Caucus, which includes the Congressional Asian Pacific American Caucus (CAPAC), Congressional Black Caucus (CBC), and Congressional Hispanic Caucus (CHC), joined more than 60 of their colleagues on a letter advocating for closing the coverage gap through the American Families Plan.

“Even as we welcome the result of last week’s Supreme Court decision upholding the ACA, there is something amiss in the 12 states that have not expanded Medicaid, where millions of Americans are left out of this coverage,” said Majority Leader James E. Clyburn (D-SC-06). “Of those 12 states, nine of them are in the South, where there are large pockets of poverty. Medicaid expansion would be such a tremendous benefit to South Carolinians who fall into this coverage gap. We must act to close this coverage gap now.” 

“Over the past year, we have seen just how important it is that everyone has access to quality, affordable health care whenever they need it. And closing the gap is vitally important not only to people without insurance, but to all of us,” said U.S. Rep. Robin Kelly (D-IL-02). “Our public health depends on as many people having access to care as possible. Medicaid expansion has played a critical role in reducing racial disparities in access to care, and closing the coverage gap will help families get back on their feet after this pandemic and help to finally address the health disparities that persist in our country.”

“There is a stark situation in the states that have not expanded Medicaid, where income eligibility rules are incredibly stringent. In most of these states, if you’re a single mother with two children and you make $9,000 per year, you’re not eligible for Medicaid,” said Yvette Fontenot, Policy and Legislative Affairs Consultant for Protect Our Care. “These states have not been persuaded to change course in the face of generous federal financial incentives, evidence of the health benefits of Medicaid expansion, and the worst pandemic in a century. Waiting for them to act is no longer a viable option.” 

“Medicaid is a lifeline for millions of Americans, and its importance has never been more clear as it has reached record enrollment during the pandemic,” said Protect Our Care Chair Leslie Dach. “Despite the overwhelming benefits of Medicaid expansion, and even with the additional incentives included in the American Rescue Plan, Republicans have put politics over people by continuing to reject the program. Lawmakers must act quickly to provide relief to millions of people who have been locked out of coverage by adopting a federal solution to expand Medicaid in the American Families Plan.” 

BACKGROUND:

• • Six Million People Could Gain Coverage If Remaining Holdout States Expand Medicaid.  An estimated four million uninsured adults — including at least 2.4 million people of color, 640,000 frontline workers, 500,000 people with disabilities, and 926,000 older adults aged 50 to 64 — could gain coverage if the remaining holdout states adopted expansion. In total, roughly 6 million people could enroll in Medicaid if the remaining states implemented expansion.
  • Medicaid Expansion Is Widely Popular. In 2020, the country saw voters in two deeply conservative states, Oklahoma and Missouri, approve expansion. 75 percent of Americans have a favorable view toward the Medicaid program, and 61 percent of Americans in non-expansion states favor expansion. 
  • Medicaid Expansion Results In Healthier Communities. Research confirms that Medicaid expansion increases access to care, improves financial security, leads to better health outcomes, and even saves lives. Medicaid expansion has played a vital role in reducing racial disparities in health care access and has served as a critical safety net during the pandemic. According to the Kaiser Family Foundation, more than 600 studies confirm the broad benefits of Medicaid expansion. 

Yesterday, the New York Times reported that Medicaid enrollment surpassed 80 million nationwide, meaning one in four Americans are now covered by the program. For decades, Medicaid has been a vital source of coverage for millions, including seniors, children, women, and people of color. And amid vast economic insecurity and widespread coverage losses during the pandemic, Medicaid has once again proven to be a critical safety net, ensuring access to quality, affordable health care for millions more. 

The Affordable Care Act’s Medicaid expansion in particular has helped more Americans get covered. Research confirms that Medicaid expansion increases access to care, improves financial security, and leads to better health outcomes. However, in 12 states, Republican leaders have rejected Medicaid expansion, blocking millions of people from access to coverage. At least 2.4 million people of color, 500,000 people with disabilities and almost a million older Americans who are currently uninsured could gain Medicaid coverage if the remaining states adopted Medicaid expansion. Recent reporting from The New York Times highlights what states have gained, and have to gain, from the surge in Medicaid enrollment.

Medicaid’s Growing Role

One in four Americans now has health coverage through Medicaid. 10 million Americans enrolled in Medicaid in 2020, bringing the national program to a record total of 80 million participants. This trend represents Medicaid’s crucial role within the American health system.

Medicaid holdout states are denying coverage to millions. 12 states have refused Medicaid expansion, blocking essential health coverage for four million uninsured Americans. Increases in access to health care play a critical role in improving health outcomes.

10 Million Americans Joined Medicaid In 2020. Over a 12 month period, Medicaid enrollment grew by 14 percent. This figure includes CHIP enrollment, which covers the children of individuals who cannot afford coverage, but do not qualify for Medicaid. 

Medicaid Is A Pillar Of The U.S. Health System. Medicaid’s rapid growth in 2020 illustrates the program’s crucial role in American healthcare. Once viewed as a safety net, Medicaid has evolved to demonstrate American’s need and desire for affordable health coverage. CMS Administrator Chiquita Brooks-LaSure said the increased enrollment “tells us that Medicaid is a critical program for American families.” 

Blocking Medicaid Expansion Is Hurting Millions. There are currently 12 states that have rejected federal funding to expand their Medicaid programs and cover adults up to 138 percent of the federal poverty level. Republican leaders in these states have blocked at least 2.4 million people of color, 500,000 people with disabilities, and nearly one million older Americans who are currently uninsured, but could gain coverage if Medicaid expansion was adopted. 

Americans Favor Expansion. Three recent holdout states, Idaho, Nebraska, and Utah, expanded Medicaid in 2020 under the direction of voters through ballot initiatives and experienced a rapid surge of enrollment. Next month, Oklahoma will finalize its Medicaid expansion program. 

Washington, D.C. — Today, Senate Finance Committee Chair Ron Wyden released “principles of reform” to provide a framework for comprehensive legislation to reduce drug prices. The principles include strong measures, including giving Medicare the power to negotiate for lower drug prices. In response, Protect Our Care Chair Leslie Dach issued the following statement: 

“We commend Finance Chairman Ron Wyden for his leadership and dedication to lowering drug prices for all Americans. The principles released today are a strong foundation and an important step forward. Americans are paying far too much for prescription drugs, and these principles provide a pathway to a real and meaningful solution.  

“The Finance Committee principles would give Medicare the power to negotiate for lower prices and the teeth to bring PhRMA to the negotiating table and keep them there, and make those prices available to as many Americans as possible. While there are many important details to be worked through, if enacted into law, these principles would address launch prices, reduce out-of-pocket costs for seniors, and limit price increases to the rate of inflation for drugs that have been on the market for years.  

“It’s time to put an end to the greed of big drug companies. Americans should not have to pay three times more for the same medicines as people in other countries, and they shouldn’t have to choose between paying for the drugs they need to stay alive and paying for housing or food. Today’s announcement from the Senate Finance Committee, coupled with the introduction of H.R. 3 and the leadership of Speaker Pelosi in the House and President Biden’s vocal support, provides real momentum to finally bring down drug prices.”

As part of Week 3 of Lower Rx Summer, Protect Our Care is releasing a new fact sheet outlining how the robust savings achieved under Medicare negotiation could be used in part to improve health care for seniors and older adults. Giving Medicare the power to negotiate lower drug prices will help patients save more than $100 billion dollars on their drug costs and will generate nearly $500 billion in additional savings, which can be reinvested to strengthen health care for millions of Americans, including for seniors. These savings could help establish an out-of-pocket cap for drug costs under Medicare and expand Medicare benefits to include hearing, vision, and dental. 

President Biden And Leading Democratic Members Of Congress Are Proposing Using The Savings From Medicare Drug Price Negotiation To Add Dental, Vision, And Hearing Benefits To Medicare 

President Biden’s Budget Includes Expanded Medicare Benefits For Seniors. President Joe Biden’s FY 2022 budget proposal includes a plan to improve “access to dental, hearing, and vision coverage in Medicare.” 

Senate Majority Leader Chuck Schumer And Senate Budget Committee Chair Bernie Sanders Support Expanding Medicare Benefits. Senate Majority Leader Chuck Schumer supports an effort, led by Sen. Bernie Sanders, to add dental, vision and hearing coverage to Medicare. “There is a gaping hole in Medicare that leaves out dental, vision, and hearing coverage. This is a serious problem,” Schumer wrote on Twitter. “I’m working with @SenSanders to push to include dental, vision, and hearing Medicare coverage in the American Jobs and Families Plans,” 

More Than 150 House Democrats Support Adding Dental, Hearing, And Vision Benefits To Medicare. More than 150 House Democrats from across the party signed a letter in support of expanding Medicare’s benefits citing “a critical need to improve the traditional Medicare benefit to include dental, vision, and hearing.” 

AARP Is A Strong Supporter Of Adding Dental, Hearing, And Vision Benefits To Medicare. AARP is a strong supporter of efforts to add vital coverage for dental, hearing, and vision to Medicare Part B and has endorsed The Lower Drug Costs Now Act (H.R. 3), historic legislation that gives Medicare the power to negotiate for lower drug prices for all Americans . 

Dental Coverage 

Most Seniors Don’t Have Dental Insurance And Many Go Without Needed Care Because Of The Cost. According to the CDC, in 2017, slightly less than one-third (29.2 percent) of adults aged 65 and over had dental insurance, and 7.7 percent of seniors skipped needed dental care because of concerns about the cost. Among Medicare beneficiaries who used dental services, average out-of-pocket spending on dental care was $874 in 2018, and one-fifth spent more than $1,000 out of pocket.

Seniors Overwhelmingly Support Adding A Dental Benefit To Medicare. Recent polling from the University of Michigan found that 93 percent of older adults said they would favor a policy that would add a dental benefit to Medicare.

Vision Coverage 

Nearly Every Medicare Beneficiary Uses Corrective Lenses. A 2015 study found that 92.4 percent of Medicare beneficiaries reported using eyeglasses for either distance or near vision correction. Less affluent Medicare patients were less likely reporting using eyeglasses, suggesting that many seniors may be avoiding needed vision care because of the costs. 

The Average Cost Of An Eye Exam And Glasses Without Insurance Is More Than $500 — A Significant Burden On Seniors Without Vision Coverage. According to VSP Vision Care, the average cost of an eye exam, glasses, and frames for those without vision coverage is $576. Untreated vision problems are associated with an increased risk of falls, depression, cognitive impairment, hospitalization, and limited mobility for seniors. 

Hearing Coverage 

Millions Of Seniors Go Without Hearing Aids Because Of Costs. A University of Michigan study found that just over a third of older adults who say they have hearing loss are using a hearing aid to correct it, with cost being a prohibitive factor. Hearing aids can cost thousands of dollars out of a patient’s pocket because most health insurance programs, including Medicare, don’t cover them.

Untreated Hearing And Vision Loss Puts Seniors’ Health At Risk. Untreated hearing loss in older adults can lead to a variety of physical and mental health problems. Hearing loss increases the risk of dementia, falls, and depression and may increase social isolation and reduce cognitive function. 

Capping Out Of Pocket Drug Costs 

The Democratic Plan To Reduce Drug Prices Would Cap Out Of Pocket Drug Costs For Seniors. In addition to giving Medicare the power to negotiate drug prices, the H.R. 3 would also limit prices so they could not rise faster than inflation and cap how much Medicare beneficiaries pay out-of-pocket each year at $2,000.

Nearly Nine In Ten Seniors Currently Take Prescription Medication, With Millions Struggling To Afford The Cost. One in four adults over 65 report difficulty affording their prescription drugs. Seniors most likely to experience difficulty are: in poor health, have an annual household income under $30,000, and/or take four or more prescription medications. 

Medicare Has No Out-Of-Pocket Limit For Prescription Drugs. Individuals on Medicare are the only insured Americans to have no cap for out-of-pocket medication costs. Once Medicare beneficiaries are out of the coverage gap and have obtained catastrophic coverage, they are still responsible for coinsurance and copayments costs.

Out-Of-Pocket Costs For Specialty Medications Are Skyrocketing. Even with catastrophic coverage, Medicare Part D enrollees can face thousands of dollars in out-of pocket expenses for specialty drugs. Kaiser Family Foundation anticipated the average 2019 out-of-pocket cost for specialty drugs to be $8,109. 

High Out-Of-Pocket Costs Force Seniors To Forgo Medications. One in five seniors report not taking their medications as prescribed due to cost. A 2021 study found that increasing out-of-pocket costs by only $10 created a 23 percent decrease in Medicare beneficiaries taking prescription drugs as instructed, as well as a 33 percent increase in mortality. 

Seniors Are Forced To Put Off Retirement To Access Needed Drugs. Without a limit on out-of-pocket costs for prescriptions, many older Americans continue working to retain access to employer insurance plans which offer additional coverage. Postponing the transition to Medicare also allows for the continuation of financial assistance from pharmaceutical manufacturers, not available to Medicare beneficiaries.