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Before the caps, "there were a lot of people who were facing really high out-of-pocket costs, sometimes $10,000 (or more) per year," said Leigh Purvis, prescription drug policy principal at AARP ...
AARP officials said they expect more lawsuits to be filed once the list of targeted drugs is published on Aug. 29, just days before the Sept. 1 deadline CMS had originally set.
A 2023 survey by the KFF health research firm found that 11% of Medicare beneficiaries delayed or went without their prescription drugs in the previous year due to cost.
The Medicare Prescription Drug, Improvement, and Modernization Act, [1] also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. [2] It produced the largest overhaul of Medicare in the public health program's 38-year history.
When used appropriately, formularies can help manage drug costs imposed on the insurance policy. [7] However, for drugs that are not on formulary, patients must pay a larger percentage of the cost of the drug, sometimes 100%. Formularies vary between drug plans and differ in the breadth of drugs covered and costs of co-pay and premiums.
Only 38% of drugs approved in the 1990s and 19% of the drugs approved since 2000 were on the formulary. [ citation needed ] In 2012, the plan required Medicare beneficiaries whose total drug costs reach $2,930 to pay 100% of prescription costs until $4,700 is spent out of pocket.