Congress mulls cap on what Medicare enrollees pay for drugs

Associated Press

WASHINGTON

With health care a top issue for American voters, Congress may actually be moving toward doing something this year to address the high cost of prescription drugs.

President Donald Trump, Democrats trying to retire him in 2020, and congressional incumbents of both parties all say they want action. Democrats and Republicans are far apart on whether to empower Medicare to negotiate prices, but there’s enough overlap to allow for agreement in other areas.

High on the list is capping out-of-pocket costs for participants in Medicare’s popular Part D prescription drug program, which has a loophole that’s left some beneficiaries with bills rivaling a mortgage payment.

The effort to cap out-of-pocket costs in Medicare’s prescription plan is being considered as part of broader legislation to restrain drug prices.

Limits on high medical and drug bills are already part of most employer-based and private insurance. They’re called “out-of-pocket maximums” and are required under the Obama-era health law for in-network services. But Medicare has remained an outlier even as prices have soared for potent new brand-name drugs, as well as older mainstays such as insulin.

At a recent House Ways and Means Committee hearing, three expert witnesses with varied policy views concurred on limiting drug costs for Medicare beneficiaries. “This is still the only program that does not provide that protection to its beneficiaries,” testified economist Joe Antos of the business-oriented American Enterprise Institute. The House committee also oversees Medicare.