Decisions in seniors’ days should include what they will wear, what they will eat for lunch or if they’d rather go to the park or the library — not whether to buy food or their blood pressure medication.
Unfortunately, too many seniors take many medications to manage chronic diseases, which is called polypharmacy. The statistics show that two or medications are common, but we know seniors who take as many as fifteen a day.
That’s a lot, even before considering that some of those are taken multiple times each day.
Medications are expensive. Whether your senior is covered under a Part D medication plan or another plan that covers their medications, the reality is that more and more of the prescription drugs they need are not being covered. Our senior loved ones must choose the generic brand, switch to a different drug and visit the doctor more often to get their prescriptions reviewed in the current healthcare environment.
Seniors’ Health Plans Often Not Enough
We heard a story the other day about a senior who was fully covered with a drug plan but didn’t respond fast enough to the ‘through the mail’ pharmacy about whether they accept generics and was billed $500 out of pocket for the name brand, which was not covered under their plan.
The standard drug benefit in 2014 has a $310 deductible and 25% coinsurance up to an initial coverage limit of $2,850 in total drug costs, followed by a coverage gap. Yes, even that sounds complicated, even before getting the medications themselves. During the gap, enrollees are responsible for a larger share of their total drug costs than in the initial coverage period, until their total out-of-pocket spending reaches $4,550.
The monthly Part D premium averaged $39.90 in 2013. Enrollment in part D prescription drug plans is voluntary. If your senior doesn’t select a plan, they are enrolled automatically in a standard plan but the Centers for Medicare/Medicaid Services estimates 10% of seniors have no credited coverage.
Just paying the deductible and co-pays may be more than our seniors can bear when many medications are needed. It has been estimated that many seniors pay greater than $100 a month in out of pocket medication expenses. However, the real problem comes about when elders have to choose between paying for essential prescriptions and household bills including food, electricity and heat.
Many Seniors Not Getting Drugs They Need
A new study has revealed that many older adults with chronic diseases are not taking their medications as prescribed. They may be eliminating dosages, skipping certain pills or not filling prescriptions in order to pay for other things like food.
As part of the US Health Interview Survey, 9,700 adults with chronic diseases provides some troubling results.
- 23% of participants reported that they had trouble paying for their medications
- 19% of those surveyed reported be unable to put sufficient food on the table
- 11% said they had both problems
- Many reported lack of adequate insurance coverage
- Many in this population were not eligible for assistance
Too many doctors don’t ask their older patients (or any patient) if they can afford the pills they prescribe. Some medications are vital, such as those that control blood pressure, blood sugar or thin the blood to prevent stroke. The ability of our seniors to actually fill a prescription can be a major challenge and a risk some doctors don’t consider when they send the patient on their way after a visit.
Then those same doctors wonder why the medications aren’t solving the problems or controlling the symptoms.
Unfortunately, there is a ‘don’t ask don’t tell’ dynamic occurring. Elders will usually only tell the doctor what they think they want to know and offer information, especially of this personal nature when asked. It’s often hard to admit you don’t have enough money. If the doctor doesn’t ask, and then press for an answer, they aren’t going to divulge.
Doctors Can Help
Doctors, if they are aware of the situation, can help our seniors actually get the medical treatment they require without having to choose drugs over food. Family caregivers can help too.
- Be sure that your senior loved one has done everything to change their lifestyle to address any chronic diseases. These non-medicinal improvements can make a difference in the control of certain diseases. Losing weight if overweight, becoming more physically active, cutting the salt in their diet, stopping smoking, getting enough sleep and coping with stress.
- Use generics when medications are prescribed. Always ask the doctor if a generic is available. Generic medications can be as much as 90% less costly.
- If possible, and if they are acceptable to treat your senior, ask for older drugs. Many of the newer more advertised drugs are also much more expensive and also don’t have a generic equivalent. Talk with the doctor about using more cost-effective medications that produce the same benefits.
- See if the doctor will prescribe half a pill, which may be cheaper than a full dosage. Sometimes a 20 mg tablet costs less than twice as much as a 10 mg tablet and can be easily cut in half. This is a solution that comes with knowledge about the cost of drugs and may be good to get input from your pharmacist, too, on this type of option.
- Investigate prescription assistance programs that are offered by drug companies. Your senior may be eligible for assistance paying for some of their medications. You can also check with your drug store to see if they have discounted medications for seniors or a preferred provider plan that rewards your senior for using that chain. There are several online medication assistance programs that may help your senior you can search for on the internet.
- When it is open enrollment time again, check out several Part D programs to be sure you have the one that will benefit your senior the most and actually provides coverage for the majority of your senior’s prescriptions. There can be quite a difference between plans so it is worth a some time and effort to compare the costs and benefits. Your senior may also be eligible for low income subsidy, with premium and cost-sharing assistance, but they must apply through the Social Security Administration or Medicaid.
Because the cost of prescription drugs is the highest growing segment of healthcare today, it is important that family caregivers are aware of the financial burden their senior’s medications can be.
We hope that they will never have to choose between food, heat or medical help!