Proposed Bill Seeks to Lower Drug Costs for Seniors in PACE

For older Americans who enroll in the Program of All-Inclusive Care for the Elderly (PACE) but qualify only for Medicare, the cost of prescription drugs can be overwhelming. A newly introduced bipartisan bill proposes giving these enrollees the option of selecting a standalone Medicare Part D plan they can afford.

What Is PACE?

Currently available in about 30 states across the country, PACE covers many services also covered by Medicaid and Medicare. Its aim is to help frail seniors who need long-term services avoid nursing homes and instead age safely within their community.

However, Medicare beneficiaries enrolled in PACE are not permitted to obtain their prescription medications through Medicare Part D at this time. They must rely on PACE’s Part D plan, for which premiums cost more than $1,000 a month on average. In addition, these seniors miss out on the Part D out-of-pocket drug spending cap of $2,000 that legislators recently secured in passing the Inflation Reduction Act.

PACE Part D Choice Act

In November 2022, Senators Tom Carper (D-DE) and Bill Cassidy (R-LA) introduced the PACE Part D Choice Act. This legislation seeks to help seniors in PACE who qualify only for Medicare coverage to decrease the amount of money they pay for health care coverage.

If the PACE Part D Choice Act passes, these enrollees would be able to choose whether they want to use PACE Part D coverage or a standalone, marketplace Part D coverage for their prescription drug costs. The PACE Part D Choice Act stands to save seniors money by providing lower copays, deductibles, premiums, and other health care costs.

Numerous Benefits for Seniors

The PACE Part D Choice Act will give seniors greater control over their financial futures by allowing them to make choices about health care coverage. 

“It makes no sense that these older Americans cannot choose which Medicare Part D plan makes the most financial sense for them,” Sen. Carper stated in a news release. “I’m glad to introduce this bipartisan legislation that would give these individuals a choice, lowering monthly costs and, thanks to the Inflation Reduction Act, ensuring PACE participants won’t pay a dime over $2,000 a year for their medications.”

Not only does this bipartisan act improve the financial situation of seniors, but it also stands to improve the health care outcomes of seniors. According to Sen. Cassidy: “This bill ensures patients in the PACE program have the same access to lower premiums and affordable prescription drugs that lead to better health outcomes as those in other Medicare programs.”

In addition, passage of this bipartisan act could also mean that many more seniors enroll in PACE. Those who qualify only for Medicare — but had avoided PACE due to the cost of medications through PACE Part D — may now consider the program, ultimately allowing them to receive care in their community as opposed to nursing homes.