As part of its Health Action Now campaign, AARP is urging Congress and the Obama Administration to work together to ensure that all Americans have affordable health care choices, now. AARP has outlined some specific goals for reform, and AARP members throughout the Bay State have been weighing in on what is important to them.
Priced Out: Health Coverage for Ages 50-64
Even with Massachusetts’ landmark health reform law, Sue of Danvers, 62, has trouble paying for health insurance. Sue, who owns a small custom drapery business, recently had to make the difficult decision to downgrade to a health plan with a lower premium, higher deductible and less coverage. “I had no choice, I just couldn’t afford it,” she said. “Every time I think about how much it is costing me to stay insured, I feel like I’m being hit in the face.”
High Drug Costs: The Need for Generic Biologics
Suffering from Stage Four Chronic Kidney Disease, Char of Lynn, 52, requires a biologic prescription drug to maintain healthy kidney levels.
Right now, she pays $1200 each month for health insurance and expects the cost to increase once she turns 55. “My drug costs aren’t going down and when I get to the point where I need a transplant, I will then need the transplant drugs,” she explained. “After a three-year grace period, it will cost me somewhere around $500 more a month.”
Unlike traditional chemical drugs, biologic drugs are made from living organisms. The Food and Drug Administration (FDA) has no process in place to approve less costly generic versions of biologics, which can cost thousands of dollars each month. AARP has endorsed the “Promoting Innovation and Access to Life-Saving Medicine Act” (H.R. 1427/S. 726), which would create an FDA approval process – similar to that for traditional prescription drugs – for generic biologic drugs.
Medicare Part D: Close the Doughnut Hole
Last year, Patricia of Salem, 58, and her husband spent upwards of $15,000 on health care costs. In September, Patricia reached the Medicare coverage gap or “doughnut hole” and spent nearly $1000 a month on prescriptions drugs alone. “It’s a struggle,” she said. “It seems that piece by piece your savings are being taken away to the point that you could end up with nothing.”
In Massachusetts, 25% of Medicare beneficiaries with drug coverage fall into the “doughnut hole” at some point during the year. This means that they must pay $2,700 out of pocket for prescription drugs until coverage resumes.
Bay State Steps Up: Prescription Advantage Helps
Diagnosed with Leukemia in 2006, Mary Keenan of Somerville, 80, counts on Prescription Advantage, the state’s pharmacy assistance program, to help pay for her medicine when she reaches the Medicare coverage gap. “Before I reached the doughnut hole and got help from Prescription Advantage, I had to charge it and pay my credit card off a little bit each month,” she said. “I have no other choice.”
64,000 Massachusetts residents currently count on Prescription Advantage, which serves as a supplement to Medicare Part D, to help pay for the medicine that keeps them healthy and out of more expensive care. Recently, 45,000 Prescription Advantage enrollees lost initial co-payment assistance due to state budget cuts; they are still eligible for assistance if they reach the Medicare Part D coverage gap.
Get Involved Locally
Help us make national health care reform a reality this year. Become part of AARP’s volunteer team in your congressional district. Contact your legislator, share your story, voice your opinion.
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