President Biden proposes $2,000-a-year limit on prescription drugs

President Biden last night offered real hope to the millions of Americans who all too often walk away from the pharmacy counter without their medications because of what their insurance companies demand they pay out of their own pockets before their coverage kicks in.

As president of the Lower Out-of-Pockets NOW Coalition, I can’t thank the president enough for endorsing the coalition’s proposal to limit out-of-pocket costs for prescription drugs to a maximum of $2,000 a year for every one of us–not just Medicare beneficiaries.

In his State of the Union Speech, Biden took much of the credit for legislation he signed into law that next year will reduce out-of-pocket costs to a maximum of $2,000 a year for millions of retired and disabled Americans enrolled in Medicare’s Part D prescription program. 

Starting next year, Biden said:

that law caps total prescription drug costs for seniors on Medicare at $2,000 a year even for expensive cancer drugs that can cost $10,000, $12,000, $15,000 a year. Now I want to cap prescription drugs at $2,000 a year for everyone.

That was a huge victory for those of us in the coalition who came together two years ago to demand that lawmakers dismantle one of the biggest barriers insurance companies have erected to keep Americans from getting the care they need. The $2,000 cap for Medicare enrollees was part of the 2022 Inflation Reduction Act, which also reduced the cost of insulin to $35 a month and allows the federal government to begin negotiating with drug makers for lower prices. 

Our coalition supported that cap, but we told Congress and the Biden administration that the legislation didn’t go far enough. So in July, we sent a letter to Congressional leaders calling on them to do exactly what Biden proposed last night. 

The president actually went further than we could have hoped. In our letter, we asked lawmakers to set a $2,000-a-year limit on prescription drugs, starting with people enrolled in Affordable Care Act (Obamacare) marketplace plans and expanding the cap later to cover everyone. Biden said such a cap should apply to all privately insured Americans right away.

Lower Out-of-Pockets NOW Coalition’s letter that was sent to Congressional leaders

As we noted in our letter, far too many Americans “are having to make choices between putting food on the table and getting the care we need. When we go to the doctor or pharmacy counter, we find out all too often that our share of the bill is beyond our ability to pay.”

Whether the president and Congress will follow through on this depends on us. As we all know, just because Biden called for the cap doesn’t mean it will happen without a fight. Insurance companies like the ones I worked for will try to kill it. They’ll say the proposed cap will result in higher premiums. That’s not true. Insurers have made hundreds of billions of dollars in profits since the ACA was passed in 2010, in large part by saddling patients with unaffordable out-of-pocket demands the ACA allowed. 

What Biden is calling for would be a long-needed fix to the ACA. Let’s tell him–and members of Congress–we have their back in this fight.