Perhaps a select set of medical supplies should be covered under a “catastrophic” plan along with medications. Then at least the amount a household spends on “medical” costs would be capped at a percentage of the annual household income. After all the whole idea behind the catastrophic plan is to make sure people don’t go broke from medical expenses.
Especially give the lack of uptake on the catastrophic drug plan.
References
How is cost assistance calculated?
Your annual out-of-pocket costs for eligible prescription medications will be capped at an amount not to exceed a set percentage of your household income. Eligible prescription medication costs for the remainder of the year from July 1 to June 30 will be paid through the Catastrophic Drug Program.
Your annual out-of-pocket costs for eligible prescription medications will be capped at an amount not to exceed a set percentage of your household income. Eligible prescription medication costs for the remainder of the year from July 1 to June 30 will be paid through the Catastrophic Drug Program.
| Total annual household income | Percentage rate of annual income you pay on prescription medication costs before assistance |
| Up to $20,000 | 3% |
| Greater than $20,000 to $50,000 | 5% |
| Greater than $50,000 to $100,000 | 8% |
| Greater than $100,000 | 12% |
Example:
Annual household income: $25,000 x 5% = $1,250 cap
Once you have spent $1,250 for eligible prescription medications, you will be covered by the Catastrophic Drug Program for additional approved medication costs for the remainder of the year (July 1 – June 30).
If you apply past the program start date of July 1, your cap will be pro-rated to reflect the percentage of time remaining until June 30.
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