A bill to lower drug costs for participants in Programs for All-Inclusive Care for the Elderly (PACE) could be the shot in the arm the program needs to expand.
Last week, Sens. Tom Carper (D-DE) and Bill Cassidy introduced the Medicare Part D Choice Act which would save Medicare-only PACE enrollees up to $972 a month. The legislation would let PACE enrollees choose their prescription drug plan under Medicare Part D and save more on monthly drug costs.
“PACE participants in Delaware and across our nation are dealing with rising prescription drug costs every time they need a refill for their life-saving medications,” Carper said in a statement. “It makes no sense that these older Americans cannot choose which Medicare Part D plan makes the most financial sense for them.”
PACE is a Medicare-Medicaid program that provides adult day services, meals and some medical care at PACE centers, in addition to home-based care. PACE enrollees are currently required to get their Medicare Part D-covered medications through PACE Part D, which has a monthly premium of just over $1,000.
Plan choices
The legislation allows PACE participants to choose between the existing PACE Part D plan or a stand-alone Part D plan, which has a monthly premium of $43. The senators said the potential savings to seniors could help Congress expand access to PACE for Medicare-only participants and future beneficiaries.
Shawn Bloom, president and CEO of the National PACE Association, said allowing Medicare beneficiaries to enroll in a separate Medicare Part D plan would eliminate a huge financial barrier for many seniors interested in the program.
“NPA urges Congress to pass this bill quickly so that many more older adults and their families can be served by PACE and receive the care they need in their homes and communities,” Bloom said in a statement.
Inflation Reduction Act omission
The legislation helps to expand on drug coverage relief offered by the Inflation Reduction Act. In a guest column in August on McKnight’s Home Care, Bloom lamented that the act, which capped Medicare Part D drug costs at $2,000 a year for Medicare enrollees, left out PACE participants. He blamed the omission more on technical oversight than policy intent.
“Because the Inflation Reduction Act aims to limit the expense of Part D coverage by capping co-pays and deductibles, PACE participants, whose expense for coverage is entirely based on the premium they pay, won’t have the same cost protection benefits as other Medicare beneficiaries,” he wrote.
Although the PACE program has been touted in Washington as a way to help seniors age in place, the program has had trouble gaining traction nationwide. It is currently offered in 32 states with approximately 60,000 enrollees.
