Prescription drug costs are front and center in the health-care debate. Caregivers know very well why this is. They see prices for their loved one's medications skyrocketing, which poses financial challenges and forces difficult choices.
In fact, overall prices for medication are rising faster than the pace of inflation, with brand-name and specialty drugs costs going up more than twice the rate of inflation. Sometimes, family members end up helping to foot the bill for medications out of their own pocket.
To help you and your family cope with rising drug costs, I'd like to let you know about some useful resources.
Does this sound familiar? Your great aunt has seven different prescriptions, all neatly lined up on the kitchen counter. As her caregiver, you are pleased. She appears so organized.
Yet you also note that one drug bottle is from the pharmacy down the block, another one is from across town, three are from a local supermarket, and two are from a mail-order pharmacy.
You ask, "Auntie, why so many drugs from so many different pharmacies?"
"Oh honey," she replies. "I just want to get the best deal for my money, you know, so I shop around. If the corner pharmacy tells me my blood-pressure pills cost $50, I go to the pharmacy across town. They can sometimes fill it cheaper."
Your aunt is like me, a comparison shopper. Many of our parents trained us to be savvy consumers, or we just learned it ourselves. Prices can vary from store to store, but when it comes to prescription drugs, there are other, healthier ways to save money.
Saving Money for Medicare Part D Beneficiaries
Today, Medicare beneficiaries have prescription-drug coverage. That's a good thing; however, the coverage is not complete. This year, more than 3 million Medicare Part D beneficiaries risk falling into a drug-coverage gap called the "doughnut hole."
In 2009, Medicare will cover the cost of prescription drugs up to $2,700.
After that, there is no coverage whatsoever. We call this gap the "doughnut hole."
You can "come out of the hole" once your loved one's out-of-pocket expenses reach $4,350.
At that point, the person receives coverage again, for 95 percent of his or her costs. This is called "catastrophic coverage."
So, while in the doughnut hole, Medicare Part D enrollees pay 100 percent of their medication costs, all the while still paying their monthly premiums. For some people, the added costs are unexpected, and, for many, the gap becomes a financial trap.
It is estimated that more than 3 million people will fall into the coverage gap, and when they do, their prescription costs double. In these cases, there are often disastrous results. You may know a family member who has skipped pills or postponed or cut back on medical care because of its expense. Alternatively, many older adults cut back on food, utilities, and other essentials to be able to afford their daily meds.
But there is some help. Here a few resources worth knowing about if you want to help your loved one save money on prescription drugs.
Talk to a Real Person!
I can't say enough wonderful things about State Health Insurance Assistance Programs (SHIPs). They provide personal counseling and assistance to millions of Medicare beneficiaries and their caregivers. Helping people navigate the Medicare program and the increasingly complex world of health care is SHIPs specialty.
They also provide accurate, understandable, and objective information, counseling, and assistance to families on a wide range of health-insurance issues, including Medicare, Medicaid, long-term care, and prescription drugs.
Usually housed in local Area Agencies on Aging, SHIPs are staffed with dedicated, well trained professionals and often with skilled volunteers. These folks really know their stuff. They provide assistance over the phone or, in many cases, in person. They'll ask detailed health and income questions, but all of the information remains confidential. They'll use this personal data to determine which programs your loved one may be eligible for, such as a low-income subsidy program or a state prescription-drug assistance program.
Since states approach drug-assistance programs differently, eligibility standards and the range of programs available to residents vary. It is best to contact your state, county, or parish SHIP program directly, or to call your local or state Department on Aging, to learn about what's available for your older family member.
AARP's New Doughnut Hole Calculator
This is a great new resource and could not have come at a better time. By autumn, many Part D Medicare enrollees have fallen into the coverage gap. With this calculator, you can find out whether or not there are less expensive drugs that could help save your loved one money.
The great news is that the calculator is so easy to use even I can do it! (Believe me, that says a lot.) The other good news is that the system ensures privacy. No patient information is ever saved. You just get information on the best, lowest-cost, safest, and most effective medications. All you have to do is type in the drugs your loved one takes and his or her ZIP code. That is as personal as it gets. And you can do this all online, from the comfort of your home.
Here is what you get when you use the calculator:
You'll see on your screen a list of similar, less expensive drugs, such as generic versions, which are just as safe and effective, but cheaper. (If no generics exist, the tool will let you know.) The calculator also searches for similar drugs that might cost less and may be used to treat the same condition.
Then the tool recalculates to show you how the savings generated from switching to the suggested drugs would prevent or delay your older family member from falling into the coverage gap or doughnut hole.
You can print out a letter to take to the doctor to talk about whether or not the lower-cost drugs you find are right for your loved one. The letter lists for the doctor the drugs your family member is taking, the names of the alternatives, and the differences in cost.
Go ahead and give it a try now: aarp.org/doughnuthole.
What you end up with is with some great information, including a chart showing your older family member's likely drug costs under his or her plan, month by month throughout the year. You'll also see a projection of when your loved one might hit the doughnut hole and how much that would cost him or her. Wouldn't it be great if you could help your loved one better manage on limited resources in these tough economic times?
The Partnership for Prescription Assistance
Did you know that some drug companies might also help? The Partnership for Prescription Assistance is sponsored by pharmaceutical companies who have joined with other public and private programs to offer free or very low cost brand-name prescription drugs to those who qualify.
Each participating program has its own set of eligibility criteria, such as level of income, existing prescription-drug coverage, whether or not the doughnut hole is in play, and more. To see if the program might help your family member, you can go to its Web site, pparx.org, or call, toll-free, 1-888-4PPA-NOW (1-888-477-2669).
Lowering Prescription Costs for Your Older Family Member
Today, we all benefit from what I like to call "better living through chemistry." It's true that drugs can improve the quality of life of many older adults, helping them live longer and better. Clearly prescription medicines are an essential component of care for your loved one, so caregivers are interested in making sure that all drugs are properly prescribed, taken, and finally, affordable.
In this time of recession, we are all seeking savings. You now have a number of resources that may lower your older family member's drug costs. In your role as a caregiver, I hope AARP's Doughnut Hole calculator and these other programs can help you keep your loved one's drug costs under control and reduce financial strain.
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