PACE Advocates Decry High Drug Prices for Program Participants

This article was originally published on McKnights Home Care.

Aging care stakeholders on Monday urged Congress to alleviate financial burdens for Program of All-inclusive Care for the Elderly (PACE) participants, who often face exorbitant costs for prescription medications.

These high costs are due to the so-called PACE Part D penalty, according to the National PACE Association. The typical Medicare beneficiary can shop for an affordable Part D plan to choose the option that meets their health and financial needs. In contrast, PACE participants who are eligible for Medicare are required to enroll in the PACE Medicare Part D drug benefit, which has premiums that are 22 times higher, on average, than the typical Medicare beneficiary’s.

This penalty not only results in high drug-related costs for Medicare-eligible PACE participants — up to $11,000 annually — it also prevents Medicare beneficiaries with complex care needs from entering PACE to begin with, the association said Monday.

“As millions of baby boomers retire and decide how they want to age, people enrolled in Medicare with complex care needs should have the option of receiving high-quality, long-term care in their home and community,” Shawn Bloom, president and chief executive officer of the National PACE Association, said Monday in a statement. “Congress must end the PACE Part D penalty before the legislative session finishes so more older adults in need can benefit from the proven care and support the PACE program provides.”

The National PACE Association urged lawmakers to pass the PACE Part D Choice Act, which would allow program participants to choose an affordable drug coverage plan from the Part D marketplace. Estimates suggest that the legislation would save PACE participants as much as $1,000 each month on prescription drug premium, according to the association.

“More older adults need to be able to take advantage of the coordinated, home- and community-based care that’s at the heart of PACE,” Bloom noted. “But that’s only possible if Congress ends the PACE Part D penalty, which will encourage more people in Medicare to sign up for the program.”

Lawmakers sponsoring the PACE Part D Choice Act include Sens. Tom Carper (D-DE) and Bill Cassidy (R-LA), and Reps. Brad Wenstrup (R-OH) and Earl Blumenauer (D-OR). In July, Sens. Bob Casey (D-PA) and Mike Braun (R-IN) introduced the PACE Anytime Act, which would eliminate time restrictions on PACE enrollment.