Medicare Beneficiaries Saved Billions on Drugs Through ACA

The Centers for Medicare and Medicare Services (CMS) recently announced that from 2010 to today, millions of Medicare beneficiaries have saved more than $26 billion on prescription drugs.

Seniors and individuals with disabilities insured through Medicare have continued to see improvements to healthcare and savings that can be attributed to the Affordable Care Act (ACA), according to a press release from the CMS.

Since the health law was implemented, more than 11.8 million individuals received significant discounts on prescription drugs, which was an average of $2272 per person.

In 2016, more than 4.9 million Medicare beneficiaries saved more than $5.6 billion, an average of $1149 per individual, according to a report from the Department of Health and Human Services. The savings in 2016 increased from $5.4 billion the previous year.

Medicare beneficiaries can receive preventive services without cost-sharing, which may remove a treatment barrier for many individuals. Approximately 40.1 million beneficiaries received at least 1 preventive service without a co-pay or deductible in 2016, which was more than in 2015, according to the release.

Nearly 1 million more beneficiaries enrolled in traditional Medicare had an annual wellness visit in 2016 compared with 2015, and more than 10.3 million Medicare beneficiaries, including those in Medicare Advantage plans, received this service.

This announcement is a last ditch effort to demonstrate the positive effects of the ACA, and to inspire further changes that include paying providers for valuable care, using healthcare data, and discovering new ways to streamline care that improves quality, according to the press release.

The ACA has made healthcare more affordable for individuals by providing certain services without cost-sharing, and closing the Medicare Part D donut hole. Additionally, Medicare has already exceeded the goal of changing 30% of fee-for-service payments over to new alternative payment models, and will likely reach 50% by 2018, the CMS reported.

A major reason the ACA has saved billions on prescription drugs is because it has reduced the gap in drug coverage that is commonly referred to as the donut hole. This occurs when beneficiaries are required to pay the full cost of prescription drugs once they hit their coverage limit, but were still under the limit for catastrophic coverage.

The donut hole is expected to be fully closed by 2020, according to the CMS. Under the ACA, any beneficiary who reaches the donut hole received $250 in 2010. In 2011, these beneficiaries received discounts on covered drugs, and in 2017, they will receive up to 60% off the cost of branded drugs and 49% off of generics, the CMS reported.

If this coverage is repealed, some Medicare beneficiaries will not be able to afford their prescriptions, and may choose to forego necessary treatment. This could lead to increased costs related to hospitalizations and adverse events.

"While the Affordable Care Act has expanded coverage to 20 million Americans, the law is also a game changer for millions of older Americans,” said CMS Acting Administrator Andy Slavitt. "These benefits are providing seniors and people with disabilities with Medicare coverage increased financial security and the guarantee that they can get an important preventive screening without cost to them.”