Prescription medications play a vital role in treating illnesses, alleviating symptoms, and managing chronic health conditions. However, the high costs of prescription medicines can make them difficult to access. High copays, even with insurance, may place undue financial stress on individuals who need these medications to stay healthy.
The burden of high prescription drug costs is disproportionately felt by older adults. The likelihood of taking prescription medications increases as one gets older and encounters a greater number of age-related health conditions. According to research from the Kaiser Family Foundation (KFF), 89% of adults age 65+ currently take prescription medications, compared to less than half of adults under 50. Older adults are also more likely to have multiple prescriptions. AARP reports that Medicare beneficiaries take an average of between four and five prescription medications each month.
Sadly, the financial burden of prescription drugs causes many older adults to forego their medications. especially for older individuals with lower incomes or who are in poorer health. Per KFF, 45% of older adults who rate themselves as being in “fair” or “poor” health report difficulty in affording their medications. Individuals experiencing more serious health problems often have more medications, leading to higher expenses and more severe consequences when medications are skipped due to cost.
Even older adults who have good prescription drug coverage through a Medicare Part D plan can feel the effects of high prescription drug prices in cases where their plan won’t cover a medication prescribed by their doctor or requires that they try a less expensive drug than the one they were prescribed. The KFF data shows that nearly half of older adults with prescription drug coverage still encounter these types of issues each year.
For our LGBT communities, where older LGBT individuals face elevated risks for chronic health conditions such as diabetes, cardiovascular disease, and certain cancers, the high costs of prescription medications are a frequent barrier to successfully managing a chronic health condition. A 2018 Williams Institute study found that LGBT older adults were more than twice as likely as their non-LGBT counterparts to have to skip or delay filling their prescriptions because of costs.
Coming out of a pandemic that has had a financial toll on millions of households, tackling prescription drug costs is essential in order to improve both the health and the financial security of older adults, especially in our LGBT communities. Lowering the cost of prescription drugs is actually quite politically popular. In an era where political agreement has become a rarity, cutting prescription drugs costs polls highly among Democrats, Republicans, and Independents. Unfortunately, this popularity hasn’t translated into legislative successes.
Legislation has been proposed in the House of Representatives to put a limit on out-of-pocket spending for individuals with Medicare Part D plans and to allow the Department of Health and Human Services to negotiate Medicare prescription drug prices. Counter proposals from Republican leadership have supported the cap on out-of-pocket costs for Medicare Part D beneficiaries but have disagreed on the government’s role in negotiating drug prices, making this a likely sticking point in future negotiations.
With legislative solutions still a ways away, there are resources that can help older adults to afford their prescriptions. In Pennsylvania, the Pharmaceutical Assistance Contract for the Elderly (PACE) program offers low-cost prescription medication to income-eligible residents age 65 and over. PACE supplements an individual’s insurance and covers the cost of medications except for monthly co-payments of $6 for generic drugs and $9 for brand name drugs. For more information about PACE, call 1-800-225-7223.
The Part D Extra Help program can help to lower prescription drug costs for income-eligible Medicare beneficiaries with a Part D plan. Many drug manufacturers run Patient Assistance Programs (PAPs) that can offer free or discounted brand-name medications to eligible consumers. Pennsylvanians living with HIV may qualify for the Special Pharmaceutical Benefit Program (SPBP) for assistance with prescriptions (New Jersey offers similar assistance through their AIDS Drug Assistance Program). The National Council on Aging’s BenefitsCheckUp® (benefitscheckup.org) can help older individuals to screen for PAPs, Part D Extra Help, and other discounts or benefit programs to help save on prescriptions.
No one should have to delay or forego their medications because of high copays or prescriptions not being covered by an insurance plan. Legislative action to remedy these issues is long overdue. Until that happens though, older adults can hopefully benefit from some of these existing programs to help manage prescription drug costs.