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From The Director
Elders and their medications: an ounce of prevention
This month Elder Services begins its 30th year of service to Berkshire County elders, and we remain committed to our mission to promote elder dignity and independence. Over the last decade, we have seen the development of a variety of medications which, when appropriately administered, allow elders to better manage their health so that they can continue to live with dignity and independence, and to maintain a high quality of life.
Unfortunately, without prescription coverage these medications are unaffordable to many elders. We at Elder Services have heard of elders who are forced to choose between their medications and food, because they can not afford both. Many try to stretch out their medications by skipping doses or by taking half doses. Elders who can not afford to take their medications as prescribed may suffer serious health effects, resulting in hospitalizations, disability, and the need for long term care, all of which are much more costly to the elder, our health care system and our Commonwealth than the expense of the medications themselves.
For the past several years, Massachusetts has attempted to respond to this dilemma through the Prescription Advantage Plan, an affordable drug insurance plan available to all Massachusetts residents age 65 and older, as well as to younger individuals with disabilities who meet income and employment guidelines. Members pay premiums, deductibles and co-payments based on their gross annual household income. A year ago at this time, the Governor proposed that the Prescription Advantage Plan be eliminated. The Legislature refused to do this, and largely restored funding for the program.
This past December, the President signed the Medicare Act into law. This law, which goes into effect in 2006, includes a Medicare Prescription Benefit. Unfortunately, this benefit will provide inadequate drug coverage and will be unaffordable to many elders. In the benefit’s first year, it is expected that a participating elder will pay a monthly premium of at least $35 monthly ($420 a year) and a $250 deductible before receiving benefits. The plan will then pay 75% ($1,500) of the next $2,000 in drug costs with the elder paying 25% ($500). At that point, coverage stops and the elder must pay the next $2,850 in drug costs out of his or her own pocket. This amount - what the elder must pay before coverage resumes - is called a “donut” because it is a big hole in the middle of the plan. Any elder who is able to afford to pay $2,850 to “fill” the donut will then have 95% of their medication costs covered until the end of the year... at which point the process begins all over begin. There is a concern that when elders reach the point in the plan where coverage stops they will be forced to miss doses, take half doses, or skip their medications entirely because they can not afford to pay $2,850 out of their own pockets. Additionally, the monthly premiums and deductible are expected to increase significantly on a yearly basis. Beginning in 2004, elders will be able to purchase Medicare subsidized discount drug cards for $30, which may help them to save money on some drugs. Unfortunately, these cards may not cover some medications, and are not expected to save more than 10% - 15% of the cost of the medications they do cover. Another troubling aspect of the new Medicare Law is that it specifically prohibits Medicare from using its tremendous bargaining power to negotiate reduced drug prices for recipients of the plan.
Perhaps the Medicare Law can be amended to provide adequate drug coverage at an affordable cost, and to allow Medicare to negotiate lower rates with the drug companies. In the meantime, Massachusetts’ Prescription Advantage Plan needs to be adequately funded so that the approximately 85,000 elders and disabled residents of Massachusetts who rely upon this drug insurance will be able to receive the medications they need. The elimination of the Prescription Advantage Plan at this time would be short- sighted and would ultimately cost the Commonwealth far more in terms of personal pain, hospitalizations, and other health care related costs, than the expense of funding the plan. As we contemplate this decision we would do well to heed the old adage, “an ounce of prevention is worth a pound of cure.”