Fighting to Preserve Prescription Advantage

As the Massachusetts House of Representatives debates the Fiscal Year 2011 budget, the status of programs and services for vulnerable residents hangs in the balance. On the cutting block again: Prescription Advantage, the state’s pharmacy assistance program that works in tandem with Medicare. Without this lifeline, 60,000 older residents will not be able to afford to fill their prescriptions.

Cut to the Bone

Over the last three years, funding for Prescription Advantage has been slashed, and slashed again – resulting in the majority of enrollees losing benefits, including initial assistance with premiums and copayments. Right now, Prescription Advantage is operating at the bare-bones level – but it still provides some of the most important coverage around, copayment assistance for those who fall into the Medicare Part D prescription drug coverage gap (the dreaded doughnut hole).

Falling into the Hole

The Medicare Part D doughnut hole begins when both an older person and his/her insurer(s) pay about $2,830 in medication costs. From that point onwards, the individual is responsible for the full cost of his/her prescriptions – until that cost exceeds $4,550. For seniors on fixed incomes, this means making decisions about whether to pay for food, rent or prescriptions. It can lead to pill-splitting, missed doses, and hospitalization.

Closing the Gap

The good news: The passage of national health care reform will close the Medicare Part D prescription drug coverage gap (the dreaded doughnut hole) by 2020 – and this year, seniors who fall into the gap will receive $250 from the federal government. But, for the next ten years – until the doughnut hole is completely eliminated – Massachusetts seniors will continue to count on Prescription Advantage to help them make it through the coverage gap.

Keeping Seniors Healthy

Even though the state continues to experience reduced revenue due to the economic crisis, AARP believes now is the time to keep critical programs and services viable for the most vulnerable. “When seniors cannot afford their prescriptions, they have no option but to stop taking often life-saving medication that keeps them healthy and out of more expensive care,” says Deborah Banda, AARP Massachusetts state director.

Members Speak Out

AARP has heard from members throughout Massachusetts about the impact of reduced coverage, and is strongly urging the Legislature to restore full funding to Prescription Advantage as part of the Fiscal Year 2011 state budget.

One member, Priscilla of Ashley Falls, was shocked to find that one of her husband’s prescriptions skyrocketed to nearly $400 for 90 pills. “If we have to keep paying at the price we are paying now either we aren’t going to be able to pay our bills or we’re going to have to take half of the medications,” she shares. “If we don’t have any more money coming in and have to put extra out for prescriptions, then I don’t know how we will do it.” 

Call Your State Legislator Today

Help protect vulnerable seniors. Dial 1-888-259-9789 (toll-free). Once connected, urge your Representative to restore funding to Prescription Advantage.

Share Your Story

Are you impacted by the change to Prescription Advantage? Please share your story with us. Email ma@aarp.org or call toll free, 1-866-448-3621.