According to a recent study, one in four Americans report difficulty affording their prescription drugs. But that reality is expected to have little or no effect on the prices consumers will face in 2020.

A new drug price forecast released in July by health care consulting firm Vizient Inc., projects a 4.5 percent average price increase in 2020. That figure tracks within a few tenths of a percentage point with the 2020 forecast published in February by Kaiser Family Foundation researchers.

It’s the latest chapter in a familiar story. Year after year prices continue to climb, eliciting a fresh round of howls from the public that are echoed by politicians, followed by little action. But it does appear that changes are finally afoot where the price of prescription drugs is concerned.

In mid-September, House Speaker Nancy Pelosi introduced a bill that would allow the Medicare program to negotiate the prices of 250 different drugs, including insulin. It would also cap out-of-pocket costs for seniors to $2,000 a year, and require drug companies to compensate Medicare when they increase prices faster than the rise of inflation.


Though these developments represent unprecedented movement on the drug price front, it’s not clear at the moment whether there is enough political will to make them reality or when, exactly, any action in Washington might trickle down to the prices that real people pay at drug stores to fill prescriptions.

Experts, though, are strangely optimistic.

Tim Lash is chief strategy officer for West Health, a San Diego-based health care policy think tank that has recently focused intently on drug prices. He believes that years of public unrest over drug prices has finally come to a turning point.

“This is the time,” Lash said. “I think we are witnessing a pivotal moment in the history of our health care system as it relates to drugs.


“The pace of developments around drug prices is just going to increase, and we are certainly expecting something to come out of the current happenings in D.C.”

But that’s still conjecture. Open enrollment for Medicare started Oct. 15, and it begins next month for company-provided health coverage. So while legislation might deliver some price relief in 2020, no one should make decisions assuming that will be the case.

There are more immediate drug cost changes in Medicare. Next year the coverage gap known as the Medicare “doughnut hole,” closes.

Since the government added prescription drug coverage in 2003, Americans have had to pay what many have considered a high percentage of costs even after they meet their deductibles. In 2019, provisions of the Affordable Care Act decreased cost sharing for name brand drugs.


Going forward, drug plan members will pay 25 percent of the cost for any prescribed medication from the time they meet the deductible until reaching the out-of-pocket spending limit, which increases from $5,100 in 2019 to $6,350 in 2020. At that point, Catastrophic Coverage kicks in, and members only pay a small coinsurance or copay for covered drugs for the rest of the year.

It’s important to note that, while the percentage of costs that beneficiaries pay after meeting their initial deductibles is smaller, the government has increased the out-of-pocket limit by about $1,200.

Tricia Neuman, director of the Program on Medicare Policy at the Kaiser Family Foundation, said seniors should be very aware of this out-of-pocket increase as they try to decide which drug plan to choose this year.

“Even if you’re only paying 25 percent of that out-of-pocket cost, that’s still an extra $400,” Neuman said.


This reality, she said, makes scouring any drug plan’s formulary — the official list of what’s covered and at what price — an absolute necessity. Formularies are always found on a plan’s official website.