CA Medicare Beneficiaries Save

Medicare beneficiaries in California have saved nearly $952 million on prescription drugs because of discounts offered through the Affordable Care Act to those who fall into the Medicare Part D "doughnut hole" coverage gap, according to a CMS report, the Sacramento Business Journal reports.

Officials said more than $11.5 billion has been saved nationally through the gradual closure of the coverage gap (Robertson,Sacramento Business Journal, 7/29).

Background

Prior to the ACA, Medicare Part D beneficiaries paid 25% of the cost of their drugs until the total bill reached $2,830. Beneficiaries then paid the full cost of drugs until their total out-of-pocket spending reached $4,550, the gap in coverage known as the doughnut hole.

The ACA called for Medicare beneficiaries in 2010 to receive one-time, $250 rebates when they reached the doughnut hole. In 2011, the rebate was replaced by a 50% discount on brand-name drugs. The discount will increase gradually until 2020, when the coverage gap will be closed (California Healthline, 3/22/13).

California Findings

In California, 139,965 Medicare beneficiaries have received a total $951.9 million in discounts on prescription drugs as a result of the gradual closure of the coverage gap, including about $123.6 million in 2014.

The average discount per beneficiary in the state was $883 in 2014 (CMS report, July 2014).