This blog is in response to Rick Studer's question, "Can you explain the current prescription drug situation compared to the state it was in before Serving Our Seniors got involved?"
Here's what I know: Our data indicates that the affordability of prescription health care has improved since Serving Our Seniors began working on the affordable medications issue in 1998. Based on the inquiries for help with medications, Serving Our Seniors has found that, generally speaking, access to affordable prescription medication has improved. (Please note that the operative words are "generally speaking".)
This is what I base my conclusion on: In 1998 Serving Our Seniors began helping older people who could not afford to fill their prescriptions. From 1998 until 2006 Serving Our Seniors was helping over 200 individuals obtain name brand drugs for free from the manufacturer. (Most of you are familiar with this program. It's advertised on TV commercials by Montel Williams.) All 200 of them could not afford the retail price of the drug, as determined by a financial assessment we conducted of each person's income and their expenses. In addition to these 200 people, we also helped another 90 individuals afford their medications that directly treated the following chronic illnesses: arthritis, high blood pressure, congestive heart failure, cataracts, glaucoma and diabetes.
Here's what's changed: Since January 2006 there has been a steady decline in the number of people age 65 or older who receive free medications from the manufacturer of that particular drug. We are no longer assisting 200 older adults obtain free medications from the manufacturer. Today, that number has gone down to 50 older adults.
Here's why: Most of the makers of these medications are not willing to give their product to patients age 65 and older anymore. Their position is that the older person should have purchased Medicare Part D (prescription drug insurance). You see, the manufacturer is encouraging sales of their product by ceasing their "give-away" program for people who are old enough to purchase Medicare Part D prescription coverage.
Here's what else has changed: Between 1998 and January 2006 we have been studying a sample population of 90 elderly individuals who could not afford to treat the one or more of the following illnesses - arthritis, high blood pressure, congestive heart failure, cataracts, glaucoma and diabetes. (These are the most common illnesses among the older population. If left untreated, these health problems take away an older person's functional independence, and make them more expensive to care for as they grow older.) In January 2006, this sample population of 90 people decreased to a sample size of 4 people.
Here's why: On January 1, 2006 Medicare Part D went into effect. Serving Our Seniors, required this sample population of older adults to sign up for Medicare Part D to remain in the study and to continue to receive financial assistance with particular medications (if needed). By doing so this allowed Serving Our Seniors to see how effective Medicare Part D was at making medicines affordable. Sixty of the 90 people earned a gross annual income equal to 150% of the Federal poverty guideline. (Simply put, 60 of those individuals we were helping with the cost of their medications were living on less than $15,000/year) Those 60 people received free Medicare Part D insurance and their co-payments were $2/drug. (Today, that co-payment per drug is $5 each) The other 30 people had to buy their own prescription coverage and their co-payments per drug varied and were more expensive that the $2-$5 per drug.
Here's what else changed: Based on our sample population, we found that 30 of the older people still could not afford their prescription medication even with their Medicare Part D insurance. They needed the financial assistance of Serving Our Seniors' "Medicine Fund" within a 12-month period.
Here's why: These 30 older adults were above the 150% of the Federal Poverty Guideline, but were far from "rich," and they took multiple medications per day. These 30 older adults didn't make enough money to afford their co-payments per drug and a monthly insurance premium or they exhausted their prescription benefit in less than 12 months and the insurance plan wouldn't pay any more toward the purchase of the drugs until their new "benefit year," (January 1st of the next year).
Here's what else has changed: In September 2007 Serving Our Seniors began receiving a huge amount of perfectly good medications, in tamper-proof packaging, donated to the Drug Repository by one of the nation's largest institutional pharmacies. The Drug Repository has more medications than we have older people who need them. For that reason, these medications are now available to anyone -- of any age -- who lacks prescription drug insurance. Through the drug repository a patient can fill their prescription for $7.40 per drug. If the doctor writes the prescription for a 90 day supply, the patient can get a 90 day supply for $7.40. There's one catch to the 90 day supply rule -- provided we have enough quantity of that particular drug in stock to dispense a 90 day supply.
PLEASE NOTE: Although the Drug Repository is a great asset to people who cannot afford their medicines, it doesn't carry the "latest and greatest" drug on the market. Januvia, for example, a new pill that treats diabetes, is not a drug that is donated to the Drug Repository. Januvia's retail cost is $181 for 30 pills. An affordable alternative for a diabetic might be an older drug, an insulin injection, but liquid medications are rarely available through the drug repository. Therefore finding affordable alternatives to treat diabetes and vision impairment are not cheap to come by.
Finally, I don't know if people are still going to Canada to use their pharmacies now that chain stores are offering specific generic drugs for $4 per prescription. Serving Our Seniors never coordinated the bus trips. This was a service that was rendered by the Erie County Senior Center, then taken over by a travel agent out of Vermilion. We rarely get inquiries from older people about accessing their medications via a Canadian pharmacy. This is a change prior to the implementation of Medicare Part D.