Prescription relief leaves out PACE participants; lets change that

This article was originally posted on Mcknights Home Care. Read the full article here.

Among the benefits of the Inflation Reduction Act is a cap on out-of-pocket spending on Part D prescriptions for Medicare beneficiaries. The legislation sets the cap at $2,000 annually. This is a positive step toward reducing the healthcare burden for seniors generally. However, it inadvertently leaves out similar protections for beneficiaries who wish to be served by Programs of All-Inclusive Care for the Elderly (PACE). This is at a time when many seniors as well as state governments are realizing PACE’s potential to change the paradigm of senior care.

This is more of a technical oversight than a policy intent. Unlike all other Part D plans, PACE does not charge co-pays or deductibles for prescriptions. Instead, Medicare beneficiaries’ payments for their drug coverage are in the form of the monthly premium they pay to the PACE program. 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.

Fortunately, legislation has already been introduced in Congress that would assure Medicare beneficiaries in PACE have the same Part D cost protections. The National PACE Association urges passage of the PACE Part D Choice Act, which would allow Medicare-only PACE participants to choose a Part D plan offered by their PACE organization or a marketplace Part D plan. The marketplace Part D plan would be more affordable and include the $2,000 out of pocket cost protections being put forward by the Inflation Reduction Act of 2022.

We are confident that by passing the PACE Part D Plan Choice bill Congress can finish the job and achieve its goal of reducing the cost of prescription drugs for all individuals covered by Medicare.

PACE programs use an interdisciplinary team approach to keep older Americans with long-term care needs healthy and cared for around the clock, while living independently in their own homes. PACE enrollees typically receive care at home; utilize a PACE center for socializing, medication management and physician visits; transportation to the PACE center and other appointments; and any other care or service needed to maintain their highest level of functioning.

PACE is a proven model of care, one that costs states and individuals less than nursing home care and allows participants to remain independent and cared for while living in their own homes.

During the COVID-19 pandemic, PACE organizations were able to continue caring for the older adults in their program, keeping them safe and well at home. In fact, PACE participants, who require a level of care comparable to older adults in a nursing home, experienced a COVID-19 infection rate and a COVID-19 death rate that was one-third the rate of nursing homes.

The Inflation Reduction Act will benefit many millions of Medicare covered individuals; we urge passage of the PACE Part D Choice Act so that PACE participants are not overlooked.