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Pay Now or Pay More Later

The old adage, “pay now or pay later” could be said to apply when it comes to cutting RIPAE (R.I. Pharmaceutical Assistance to the Elderly) as has been proposed in an effort to close state budget deficits. RIPAE is a program that pays a portion of the cost of prescription drugs that Medicare Part D insurance will not initially cover. Drugs such as those used to treat Alzheimer’s disease, arthritis, diabetes, heart problems, depression, Parkinson’s Disease, high blood pressure and a plethora of other chronic diseases are currently covered by RIPAE.

Rhode Island, faced with unprecedented budget crisis, is understandably struggling with difficult decisions about where to reduce spending to balance the budget. But AARP advocates and medical experts argue that cutting off access to prescription drug coverage for the poor elderly, particularly for those who may need them the most, should not be part of the discussion. Studies at the Drug Policy Research Group at Harvard Medical School found that denying access to medications for mental illness increased emergency care costs 17 times more than the drug savings. Another study by the Agency for Health Care Research and Quality, found among the chronically ill elderly, limits on drug benefits increased institutionalization in nursing home by almost 200%.

Data from the R.I. Department of Elderly Affairs indicate that there are approximately 18,000 people on the RIPAE program, with a varying 4,000 or 5,000 beneficiaries receiving assistance at any one time. The impact on older residents living on a fixed income will be devastating when they have to pay for their drugs at the full price charged by the manufacturer—rather than the negotiated price that the insurance companies receive. The projected savings of $1.1 million seems minuscule compared to the repercussions these cuts will have on the older residents of our state living on fixed incomes.

Those over the age of 85 are the fastest growing age group in the state. They are also the age most likely to need multiple prescriptions, and usually have been out of the work force for a number of years. Most people living this long are female and therefore have earned less over their lifetimes, and have less money to spend if their prescription coverage is eliminated, even partially.

Many of the folks who are on RIPAE are the generation who won the great war (WWII), who went to college through the GI bill, and were the first members of their families to graduate from college. They then bought homes, and never missed a payment on a 30 year mortgage, raised children and put them through college, lived frugally and saved for their old age. Is it fair to repay those who helped make our country rich and free by terminating their coverage in their time of need? Have we done our share by bringing the ever increasing and high price of drugs under control? Will our low income elders be forced to either cut their dosage in half or skip their medication altogether? If so, we can count on it leading to a decline in health, more emergency room visits, and increased admission to nursing homes. How can this be a money saving effort? It is being “penny wise and pound foolish”.

Other Resources

Rhode Island Department of Elderly Affairs (DEA)

Rhode Island General Assembly