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Life Health > Health Insurance > Medicare Planning

Biden Floats $2 Co-Pay Limits on Popular Drugs Under Medicare

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The Biden administration wants to turn the Medicare Part D prescription drug program into a force for wellness.

The administration has called for requiring Medicare drug plans to limit enrollees’ cost-sharing for anti-cholesterol drugs, drugs that control high blood pressure and other high-value drugs to $2 per prescription.

The administration put that idea in its federal government budget proposal for fiscal year 2025, which starts Oct. 1.

Presidential budget proposals have little direct effect on what the federal government ends up spending or how it changes tax revenues, but putting an attractive provision in a high-profile position in the budget proposal could give it a life of its own.

What it means: Efforts to put a $2 limit on co-payments for some kinds of high-value drugs could soon become as powerful as the forces that led to the Affordable Care Act requiring commercial plans to cover preventive care at no out-of-pocket cost for the patients and Inflation Reduction Act rules requiring government plans to limit monthly cost-sharing for insulin to $35.

Price limits could help some low-income people afford important medications, and they could encourage some middle-income or affluent people to take better care of themselves.

But poorly designed and administered price caps can also lead to shortages of some products, gluts of other products and other market distortions.

Medicare: Tables at the back of the budget show that the United States will likely lose $1.9 trillion in fiscal year 2024 on $5 trillion in revenue, compared with a loss of $1.7 trillion on $4.4 trillion in revenue for 2023.

Medicare will account for $839 billion in spending this year on $420 billion in Medicare payroll tax revenue, compared with $839 billion in spending on $358 billion in Medicare payroll tax revenue in 2023.

Medicare also generates revenue from enrollee premiums and other sources.

Medium-range forecasts show Medicare spending $1.7 trillion in 2034 and Medicare payroll taxes rising to $752 billion that year if the Biden administration budget proposal is adopted.

Medicare program additions in the budget proposal include more Medicare nutrition and obesity counseling benefits and expanded cancer care quality measurement efforts.

Medicaid: Even affluent clients may end up using Medicaid to pay for long-term care. The budget proposal calls for the government to spend $150 billion on improving home care programs, adult daycare programs and other community-based programs over the 10-year period from 2025 through 2034.

Credit: Adobe Stock


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