Lowering Prescription Drug Costs: The Biden-Harris Administration’s New Tools for Extra Help

The Biden-Harris Administration recently unveiled new tools to lower prescription drug costs for low-income seniors and people with disabilities. These tools focus on expanding the Extra Help program, a vital initiative that provides financial assistance for individuals enrolled in Medicare Part D. This program is a lifeline for many people, helping to cover their Medicare Part D premiums and cost-sharing obligations.

The Extra Help Program

The Extra Help program, managed by the Centers for Medicare & Medicaid Services (CMS), provides significant relief to those burdened by prescription drug costs. Individuals must meet specific income and resource criteria to qualify for this program. Under the newly announced changes, the eligibility for the full low-income subsidy benefit—known as the Extra Help program—expands to individuals with limited resources and incomes up to 150% of the federal poverty level, or $21,870 per year in 2023 for most individuals.

From January 1, 2024, the benefits of the Extra Help program will extend even further. Nearly 300,000 low-income people with Medicare enrolled in the Extra Help program stand to benefit from this expansion. Those currently with partial benefits that will be newly eligible for full benefits will pay no deductible or premium and enjoy fixed lower copayments for certain medications. On average, these individuals could save nearly $300 per year.

The Role of the Health and Human Services (HHS)

The Department of Health and Human Services (HHS), in collaboration with the Administration for Community Living (ACL) and the CMS, is driving the effort to lower prescription drug costs. The HHS, the largest grant-making agency in the US, provides direct grants to states, territories, tribes, and educational and community organizations. These grants are then disbursed to eligible individuals and organizations, enabling them to receive funding and support for various programs and services, including healthcare initiatives like the Extra Help program.

As part of its mission, the HHS, through the ACL and CMS, is taking action to reach eligible seniors and people with disabilities and improve enrollment in the Extra Help program. These actions include targeted efforts to reach, screen, and enroll people in the Extra Help program, focusing on Americans living in rural and underserved communities. The CMS is also releasing new national data on people with Medicare Part D prescription drug coverage who are likely eligible for Extra Help but not enrolled to raise awareness and improve enrollment rates.

The Inflation Reduction Act and Its Impact

The Inflation Reduction Act, signed into law by President Biden in August 2022, is one of the most consequential healthcare laws since the Affordable Care Act (ACA). Among other policies aimed at lowering prescription drug costs, the Act expands the eligibility for the full low-income subsidy benefit of the Extra Help program. This expansion is critical to the Biden-Harris Administration’s broader efforts to make high-quality, affordable healthcare accessible to all Americans.

In addition to expanding Extra Help benefits, critical provisions of the Inflation Reduction Act include capping a month’s supply of each covered insulin at $35 for people with Medicare, making recommended vaccines available at no cost for people with Medicare prescription drug coverage, and eliminating catastrophic cost-sharing and capping annual out-of-pocket drug costs for prescription drugs for people with Medicare Part D starting in 2024. These provisions will contribute significantly to reducing healthcare costs for many Americans.

FAQs

What is the Extra Help program?

The Extra Help program is a government initiative that provides financial assistance to eligible seniors and disabled individuals to help pay for their Medicare Part D premiums and cost-sharing obligations. The Biden-Harris administration recently announced an expansion of the program, which will take effect in 2024.

How does the Extra Help program help people with prescription drug costs?

The Extra Help program helps eligible seniors and disabled individuals by covering their Medicare Part D premiums and cost-sharing obligations. Beginning in 2024, those newly eligible for full benefits will pay no deductible or no premium and enjoy fixed lower copayments for certain medications. They could save nearly $300 per year, on average.

What is the Inflation Reduction Act, and how does it impact the Extra Help program?

The Inflation Reduction Act is a healthcare law signed by President Biden in August 2022. One of its key provisions is the expansion of the full low-income subsidy benefit of the Extra Help program. This expansion will benefit nearly 300,000 low-income people with Medicare enrolled in the program and potentially up to 3 million seniors and people with disabilities who could benefit from the program but are not currently enrolled.

What other benefits does the Inflation Reduction Act provide?

In addition to expanding the Extra Help program, the Inflation Reduction Act also includes provisions like capping a month’s supply of each covered insulin at $35 for people with Medicare, making recommended vaccines available at no cost for people with Medicare prescription drug coverage, and eliminating catastrophic cost-sharing and capping annual out-of-pocket drug costs for prescription drugs for people with Medicare Part D starting in 2024.

How is the HHS involved in the Extra Help program?

The Department of Health and Human Services (HHS), in collaboration with the Administration for Community Living (ACL) and the CMS, is spearheading efforts to expand and improve enrollment in the Extra Help program. These efforts include targeted initiatives to reach, screen, and enroll people in the program, particularly those in rural and underserved communities.

How do I apply for the Extra Help program?

You can get more information on the Extra Help program and apply at www.Medicare.gov/ExtraHelp. You can also visit SSA online at www.ssa.gov/extrahelp or call 1-800-772-1213 to enroll in the program. For one-on-one assistance with Extra Help or other Medicare questions, contact your State Health Insurance Assistance Program (SHIP) at www.shiphelp.org/ or call 1-877-839-2675 to get the number for your local SHIP.

Conclusion

The Biden-Harris Administration’s newly announced tools to lower prescription drug costs signify a significant step forward in ensuring that low-income seniors and people with disabilities receive the support they need. Through the expansion of the Extra Help program and the provisions of the Inflation Reduction Act, millions of Americans will benefit from lower healthcare and prescription drug costs. This effort is part of the broader commitment of the Administration to expand access to high-quality, affordable healthcare for all Americans.

Source: HHS.Gov