U.S. Sen. Bob Casey (D-Pennsylvania) filed legislation Thursday that would cap drug costs paid directly by people with commercial health insurance, expanding a provision of the Inflationary Reduction Act (IRA) of 2022 that placed a cap on prescription drug co-payments for Medicare recipients.
The Prescription Drug Cost Cap Act will reduce individual drug costs cost sharing Down prescription drugs to $2,000 per year and a limit on the family share of prescription drug costs to $4,000 per year. The limits would apply to both group health plans and Affordable Care Act Marketplace health plans. As of 2018, according to a memo from Casey’s office 173 million people under the age of 65 had private health insurance.
“Prescription drug costs are like a bag of rocks tied around the necks of millions of Americans, weighing them down every day,” Casey said in a statement Thursday, adding that the modern rules would build on the success of IRAs.
Under the IRAthat President Joe Biden signed into law in 2022, Medicare beneficiaries’ prescription drug costs would be capped at $2,000 per year starting in 2025, and the federal government would be able to negotiate prices for some higher-priced Medicare prescription drugs starting in 2026. About 9 million people enrolled in Medicare Part D prescription drug coverage in 2022, $3.4 billion was spent out of pocket on 10 drugs selected for negotiations, according to information from the U.S. Department of Health and Human Services.
More than 60% of adults take at least one prescription medication, According to Centers for Disease Control and Prevention, 36% of whom take three or more medications. Out-of-pocket prescription drug costs rose to $63 billion in 2021, the CDC reported.
And in 2023, The health policy organization KFF found About 31% of adults taking prescription medications said that at some point in the past year they did not take them as directed because of cost, from skipping doses to make their supply last longer, to splitting tablets in half or taking over-the-counter medications.
“Struggling families should not have to skip prescriptions, ration prescriptions, and risk their health to afford the medications they need to survive,” Sen. Raphael Warnock (D-Ga.), a co-sponsor of the bill, said in a statement.
Steven Lubin, a retired critical care nurse from Philadelphia, said he saw the need for prescription drug cost caps while working with patients at the Hospital of the University of Pennsylvania. “A lot of them for years haven’t been able to afford their medications, either all of them, or they’ve had to ration them, maybe a medication they had to take two or three times a day, and they’re only taking one a day,” Lubin told the Capital-Star.
Lubin also had personal experience with prescription drug costs; before the IRA capped insulin costs at $35, he and his wife each paid $900 a year for insulin.
“We already have enough problems with patients not remembering how to take their medications properly and how to take care of those things, but when they can’t afford to do that more often than not, it becomes an even bigger problem,” which can lead to a cascading effect on many health care problems, Lubin added.
Casey, chairman of the U.S. Senate Select Committee on Aging, and Rep. Mike Braun (R-Ind.) will lead a committee hearing Thursday to examine the high health care costs patients face and discuss actions to make care more affordable.
Update: This article was updated at 9:20 a.m. July 11, 2024, based on statements from Senators Casey and Warnock.
