Bill Overview
Title: Capping Drug Costs for Seniors Act of 2022
Description: 2022 This bill caps annual out-of-pocket spending under the Medicare prescription drug benefit.
Sponsors: Sen. Warnock, Raphael G. [D-GA]
Target Audience
Population: Seniors on Medicare globally
Estimated Size: 62000000
- The bill directly affects seniors, particularly those enrolled in Medicare, as it concerns capping out-of-pocket drug spending.
- According to the Kaiser Family Foundation, there are about 62 million Medicare beneficiaries in total.
- Not all Medicare beneficiaries are affected equally, as some might already have out-of-pocket costs below the cap.
- The bill indirectly affects families and caregivers of seniors, as reduced out-of-pocket expenses can alleviate financial burdens for them as well.
Reasoning
- The policy primarily affects senior citizens who are on Medicare and have out-of-pocket drug expenses exceeding the cap.
- Some seniors might already have low out-of-pocket drug spending or additional insurance, hence the impact can vary significantly.
- Budget constraints imply that not all seniors will experience high impacts immediately, and distribution might be phased or prioritized.
- A portion of the budget will likely go towards administrative costs and outreach to ensure eligible beneficiaries are aware of the policy.
Simulated Interviews
Retired teacher (Florida)
Age: 68 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- I've been worried about my prescriptions getting more expensive over the years.
- This policy could be a lifesaver for my budget.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 3 |
| Year 20 | 7 | 2 |
Retired engineer (California)
Age: 73 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 8/20
Statement of Opinion:
- Every year I'm paying more out of pocket for my medications.
- This act could ease the financial burden greatly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
Retired nurse (New York)
Age: 80 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- The cost of my medication has been overwhelming.
- This policy could provide peace of mind in my daily life.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 3 |
| Year 2 | 7 | 3 |
| Year 3 | 7 | 2 |
| Year 5 | 7 | 2 |
| Year 10 | 6 | 2 |
| Year 20 | 5 | 1 |
Retired librarian (Texas)
Age: 67 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- While I manage now, it's good to know this cap is there for the future.
- May not need it now, but who knows about tomorrow?
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Retired steelworker (Ohio)
Age: 82 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 18/20
Statement of Opinion:
- This cap won't change much for me since I'm covered through the VA.
- It's great for those paying out of their pocket though.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 7 | 7 |
Retired accountant (Illinois)
Age: 75 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 7/20
Statement of Opinion:
- Managing my health on a fixed income is challenging.
- This measure would greatly alleviate my financial stress.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 4 |
| Year 3 | 8 | 4 |
| Year 5 | 8 | 3 |
| Year 10 | 9 | 2 |
| Year 20 | 8 | 1 |
Retired machinist (Pennsylvania)
Age: 79 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 8.0 years
Commonness: 9/20
Statement of Opinion:
- It's been hard adjusting after my wife passed, this cap might ease my prescription worries.
- Policies like these are needed more and more.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 6 | 3 |
| Year 10 | 6 | 2 |
| Year 20 | 5 | 2 |
Retired receptionist (Arizona)
Age: 76 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 7.0 years
Commonness: 8/20
Statement of Opinion:
- I already use additional insurance that covers some costs, but do have out-of-pocket expenses.
- The cap is a comforting backstop for unexpected future costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 4 |
| Year 5 | 7 | 4 |
| Year 10 | 7 | 3 |
| Year 20 | 6 | 2 |
Retired postal worker (Michigan)
Age: 65 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 6.0 years
Commonness: 15/20
Statement of Opinion:
- I might not need the cap now, but it's reassuring as I age.
- Policy like this supports seniors' peace of mind.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 5 |
Retired seamstress (Oregon)
Age: 71 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 15.0 years
Commonness: 6/20
Statement of Opinion:
- A large part of my check goes to my medicine.
- The cap can ensure I can sustain my treatment long term.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 7 | 2 |
| Year 10 | 6 | 1 |
| Year 20 | 5 | 1 |
Cost Estimates
Year 1: $15000000000 (Low: $12000000000, High: $18000000000)
Year 2: $15500000000 (Low: $12500000000, High: $18500000000)
Year 3: $16000000000 (Low: $13000000000, High: $19000000000)
Year 5: $17000000000 (Low: $13500000000, High: $20000000000)
Year 10: $20000000000 (Low: $17000000000, High: $23000000000)
Year 100: $50000000000 (Low: $40000000000, High: $60000000000)
Key Considerations
- The cap requires careful structuring to ensure it targets beneficiaries with the greatest need.
- Pharmaceutical companies might adjust drug pricing strategies in response to the cap.