Prescription Drugs and the Elderly

Sumaiya E. Zobairi, MD

Issues

• As physician’s we feel overwhelmed/ overburdened– Multiple Chronic Illnesses– Poly pharmacy– Side Effects and Drug Interactions– Non Compliance

• For elderly patients, prescription drugs represent a overwhelming financial burden

The Financial Burden of Prescription Drugs on the Elderly and the Role of the

Primary Care Physician

Sumaiya E. Zobairi M.D.

Objectives

• To recognize the financial burden of prescription drugs on the elderly

• To comprehend the gravity of this issue as it relates to health maintenance

• To effectively address the issue with one’s patients

Financial Burden Posed by Prescription Drugs

• Anticipated expenditure from 2004-2013: $1.8 trillion

• Allocated budget of only $400 billion

Financial Burden on the Elderly

• Only 75% of community dwelling Medicare beneficiaries have prescription drug coverage

• Of these only half have continuous coverage over a 1 year period

The Dilemma

• Increasing Cost

• Inability of federal funds to keep up

• Hence, increasing financial burden on the elderly who can not afford the out of pocket expense

Reason for Increasing Cost

• A growing aging population

• Introduction of new treatments

• Direct-to-consumer advertising

The Elderly and Health Disparities:

A Closer Look

Seniors with Chronic Health Conditions & Prescription Drugs: Benefits, Wealth and

Health• Objective:

– Examine the relationship btwn prescription benefit status and the access to medications among Medicare beneficiaries

• Results: – Lacking a prescription benefit was independently associated with

difficulty affording medications and consequently coping mechanisms such as splitting pills

– Other coping strategies noted included not filling prescriptions and attempts to obtain medications from Canada through mail order

Financial Disparities in Prescription Drug Use Between Elderly and Non Elderly Americans

• Objective:– To examine the cross-sectional disparities in the financial burden of

prescription drugs use among US elderly and non elderly populations. Out of pocket spending for prescriptions, co-payment rates and proportion of family income spent on prescription drugs were examined to compare elderly people with working age adults.

• Results: – Even after utilization or need was adjusted for, financial disparities

were still observed between elderly and non elderly adult populations.

– In particular, low income elderly (125-199% of poverty) were worse off than nonelderly adults in the same poverty class and their elderly peers in other poverty classes

The Family Physician’s Role:

Recognizing the financial burden and providing assistance

Identifying Pts Inability to Obtain Prescription Drugs

• The primary care physician responsibility:

– The “3P’s”

– Polite

– Private

– Persistent

Reviewing Prescribing Habits

• Be cost conscious

• Use drug samples appropriately

Options for Patients

• Patient Assistant Programs

• State and local programs

• Pharmaceutical Manufacturer Discount Cards

• Medicare Drug Discount Card

Patient Assistance Programs

• 75 drug companies offer PAP

• 800 medications are currently offered

• In 2001: PAPs distributed prescription medications with a wholesale value of about $1.5 billion to more than 3.5 million patients

Patient Assistance Programs

• Application access• Application process• Eligibility• Cost• Response time• Deliver of medication• Amount of Medication• Refills• Re-enrollment

State & Local Programs

• State Sponsored: For Medicare Recipients, Not yet operational / postponed

• Community Health Centers: Health Resource and Services Administration

• Local Area Agencies on Aging: Texas Department of Aging and Disability Services

Pharmaceutical Manufacturer Discount Cards

Program Prescriptions Covered Annual Income Below Benefit Contact &Misc Info

GAO SmithKline OrangeCard

All drugs $30,000/Individual$40,000/Couple

At participating

pharmacies receive a

30%average savings

1-888-672-6436

LillyAnswers(Eli Lilly & Company

All drugsexceptcontrolledsubstances

$18,000/Individual$24,000/Household

At participatingpharmacies pay

$12.00/prescription for a

30-day supply

1-877-795-4559www.lillyanswers.com

Novartis Care Card

Select drugs Two Income Categories:A. $18,000 /Individual$24,000/CoupleB. $28,000/Individual$38,000/Couple

At participatingpharmacies:

A. Pay $12.00/mo. (per Prescription)

B. Receive 25% - 40% off

1-866-974-2273www.NovartisCarePlan.com

Together Rx Card

Select drugs $28,000/Individual *$38,000/Couple **Alaska & Hawaii havehigher income limits

At participatingpharmacies receive a

20-40% savings off the regularprescription price of over 155 medications

1-800-865-7211www.together-rx.com

Medicare Drug Discount Card

• Part of Medicare Prescription Drug, Improvement and Modernization Act of 2003

• Expectations:– 10-15% discount on total prescription cost

– Enrollment fee $30

– Covered drugs: most FDA approved drugs, vaccines and biological products and supplies for medication administration

Paradigm Shift

• Comprehensive healthcare reform should advocate:

– health promotion programs to reduce reliance on drugs

– And then pay, 100% of essential drugs

In Closing

• Resources are available to patients and physicians

• And yet, we are challenged to develop innovative methods of dealing with this issue, keeping in mind that public policy is so integral to the practice of medicine

References

• Cundiff David K. Medicare prescription drug benefit realities. Medscape General Medicine. 2003 Dec 10;5(4):28.

• Inglehart, JohnK. Prescription-drug coverage for Medicare beneficiaries. New England Journal of Medicine. 2003 Sep 4;349(10):923-5.

• Montemayor, Karen. How to Help Your Low Income Patients Get Prescription Drugs.Family Practice Management. November/December 2002: 51-56

• Saver, Barry G.Seniors with chronic health conditions and prescription drugs: benefits, wealth, and health. Value Health. 2004 Mar-Apr;7(2):133-43.

• Steinbrook, Robert.The prescription-drug problem.New England Journal of Medicine. 2002 Mar 14;346(11):790.

• Traynor, Kate. Drug Discount Cards for Medicare Beneficiaries to Debut This Year. Am J Health-Syst Pharm. 2004; 16; 224-225.

• Xu, KT. Financial Disparities in Prescription Drug Use Between Elderly and Non Elderly Americans. Health Affairs, 2003 Sep-Oct; Vol 22 (5), pp210-21