According to a 2019 Kaiser health tracking poll, nearly nine in ten (89%) adults 65 and older report they are currently taking a prescription medicine. Furthermore, more than half of adults 65 and older (54%) report taking four or more prescription drugs. While a majority of older adults have prescription drug coverage through Medicare Part D, which is Medicare’s voluntary prescription drug benefit, most older adults (76%) think the cost of prescription drugs is unreasonable. About one in five older adults (21%) say they did not take their medicines as prescribed at some point in the past year because of the cost. This includes those who report that, due to costs, they haven’t filled a prescription, took an over-the counter drug instead, or cut pills in half or skipped a dose. Notably, among those who report not taking their medicines as prescribed, slightly more than half say they didn’t tell their doctor or health care provider and one-fifth of this group say their condition got worse as a result of not taking their prescription as recommended.
Working in the field as a nurse Care Manager, these numbers show truth in the elderly population and the affordability of their medications. I have met numerous patients or clients who do not take their medications or cut the dosage in half due to the cost of the medication. The main chronic conditions that we see is those who are struggling with medication costs are COPD, diabetes, or heart disease. According to the Xtelligent healthcare survey, these diseases and some others fall in the category of 10 most expensive chronic diseases. From my experience, inhalers, blood thinners, and insulins are mostly tier 4 drugs that cause a great deal of financial strain in Medicare patients. These costs are very high to begin with and most the time after 2 refills, they are in a coverage gap and therefore unable to afford these medications.
Through research and 4 years of experience as a Care Manager, I have been able to find several resources to help my clients. First, several medications are eligible for a tier reduction. This will bring the medication down to a lower tier for a lower cost. However, all medications are not eligible for this and your doctor has to submit documentation to prove that this medication is the right fit for you to be eligible for tier reduction. This method will still go against the different stages in Medicare, thus will still have you reaching the coverage gap.
Another resource is the Low income Medicare, or LIS, which is extra help with Medicare and the Medicare savings programs. According to the Medicare.gov website, prescription costs are no more than $3.60 for each generic/$8.95 for each brand-name covered drug for those enrolled in the LIS program. You may qualify if you have up to $19,140 in yearly income ($25,860 for a married couple) and up to $14,610 in resources ($29,160 for a married couple).The Medicare Savings Program is a state sponsored program, in which the state will pay the member’s monthly Medicare Premiums if the member qualifies for the program. The income monthly limit is 1,084 for individual and 1,457 for couple. You can apply for these online at medicare.gov, by phone, or in person at your local office.
If you are prescribed a medication by the doctor that you cannot afford, there are a few websites that may have coupons or assistance programs. A few of them are goodrx.com, needymeds.org and rxoutreach.org. There are also some different websites that have grants for different disorders. These websites are panfoundation.org and healthwellfoundation.org. You must look up your medication or your diagnosis to see if you are eligible, and they help with the copays after the insurance pays. I have had a lot of successful getting various clients' cancer medications, inhalers, and heart medications through these programs.
The best way to get assistance with lowering the cost of your medications is to ask your doctor to assist you with any manufacturer assistance programs that they are aware of. You may be able to get the medication through the manufacturer and it will not be billed to your insurance. This helps with a coverage gap as well. If you are accepted, they send you the medication for free, usually 3 months at a time. This is the longest process in terms of documentation and eligibility, but over time it is the best resource to use.
If the cost of your next prescription is more than you can handle, I hope you can use these helpful resources to meet your needs! Always talk with your doctor for any alternates, tier reductions, or assistance programs. These medications are to be taking exactly as prescribed and not skipped or halved due to cost. Let others help you during this time!
Written By: Care Manager - Kyndra Mesimer