# Understanding the PACE Part D Choice Act of 2023

Right now, older adults enrolled in PACE programs (Programs of All-Inclusive Care for the Elderly) have to use whatever prescription drug plan their PACE provider offers. This bill changes that by letting certain PACE enrollees choose a different prescription drug plan starting in 2025, giving them more control over their medications and potentially saving them money.

PACE programs are designed for seniors who need significant care and support. They typically bundle together medical services, prescription drugs, and other benefits into one comprehensive package. The problem is that if you're in a PACE program and don't like the drug plan it offers—maybe it doesn't cover the medications you need, or the costs are too high—you're stuck with it. This bill creates an exception for people who have Medicare only (not Medicaid) and are enrolled in a PACE program. These individuals could now choose a standalone prescription drug plan from a different company, as long as that plan doesn't cost them more out-of-pocket than their PACE program's drug plan and doesn't cost the government more in subsidies either.

The bill includes important protections to make this work smoothly. PACE programs would have to inform their enrollees about this new choice and help them understand their options. If someone switches to a different drug plan and finds out their costs went up unexpectedly or their medications changed, they can switch back. Both the PACE program and the new drug plan would have to share information about the person's medications and spending so they can coordinate care properly. This ensures that even though someone's drugs are covered by a different company, their PACE doctors and care team stay informed and involved in managing their health.

PACE Part D Choice Act of 2023

Wenstrup, Brad R.

PACE Part D Choice Act of 2023 This bill allows Medicare-only beneficiaries who are enrolled in Programs of All-Inclusive Care for the Elderly (PACE) to choose prescription drug plans that are not operated by PACE. (PACE is a program under Medicare and Medicaid that provides in-home and community services for certain individuals as an alternative to nursing home care.) Specifically, the bill allows PACE enrollees who are Medicare (but not Medicaid) beneficiaries to choose a prescription drug plan that is not a Medicare Advantage plan or operated by PACE and for which annual out-of-pocket costs and federal subsidies are equal to or less than that under the applicable PACE prescription drug plan. The bill also allows for disenrollment from a chosen plan upon a change in medication or demonstration of an unexpected increase in out-of-pocket costs. PACE programs must conduct outreach, monitor data, and coordinate benefits with respect to such options.