Hawaii Seniors Struggle with Prescription Costs

By Greg Wiles, Honolulu Advertiser

Hawai

December 7, 2007

A research study by a Hawaiian physician found that a majority of over 1,000 senior citizens surveyed indicated they had difficulty in paying for medications. Patients pay out of pocket for drugs that cost more than the amount covered by their Medicare Part D insurers and because not all seniors are enrolled in a Medicare Part D plan, those that are not may stop taking medications when they can no longer afford them. The research advises physicians to ask their elderly patients if they can afford medications prescribed to them. Also, health plans should make physicians aware of the patients’ payment options and whether or not they can afford the medications. 

A new study by a Hawai'i physician has found that four of five senior citizens want doctors to ask them whether they can afford medicines being prescribed.

The research by Dr. Chien-Wen Tseng was published in the December issue of the Journal of the American Geriatrics Society and found that two-thirds of the 1,100 seniors surveyed had difficulty paying for medications. Nine in 10 wanted choices about which medicines to use.

"It's clear from this study that most people want this," said Tseng, an associate professor of medicine at the John A. Burns School of Medicine and a physician investigator at the Pacific Health Research Institute.

"Physicians need to ask and health plans need to get them (doctors) the cost information," he said.

The research underscores the problem of people at least 65 years old or older cutting back on medications or stopping altogether because they can't afford the prescriptions. Tseng said the problem is a complicated one.

Many doctors are pressed for time and don't have the luxury of checking a patient's insurance coverage and how a certain drug is covered by the patient's health insurance. She said health plans need to do a better job of making the information available to physicians.

Compounding the problem is the drug coverage varies by insurers offering drug coverage under Medicare Part D. Tseng said 71 percent of those subscribing to such plans are with programs that have the so-called "doughnut hole" in drug coverage where people must pay out of their own pocket when total drug costs are more than $2,510 and less than $5,726, the level when catastrophic coverage kicks in.

It's difficult for physicians to know how close patients are to this coverage gap and if the drugs they are prescribing will push them past this threshold, Tseng said.

The survey queried senior citizens in California about their preferences and experiences in managing drug costs. Other findings of the study, funded by the Robert Wood Johnson Foundation, include:

# One-quarter of seniors skipped, stopped or did not start medications because of cost.

# Among patients who cut drug usage because of expense, only 17 percent said their physicians had checked whether they could afford medications.

# Out of all patients, only 16 percent said physicians inquired whether the person could afford the prescriptions.

Tseng said many senior citizens don't quiz doctors about drug costs because they think doctors can't do anything about it or are too embarrassed to ask.

She said she's been guilty in the past in not talking to patients about drug costs. A senior citizen with heart disease was discharged from the hospital with drugs that cost more than $500. She said the patient's wife came back saying they couldn't afford the prescription because they hadn't gotten Medicare Part D coverage yet.

Tseng said after reviewing the medications, the doctors were able to make some adjustments for cheaper drugs and get the cost under $50.

"If that patient hadn't asked, we wouldn't have known. We had assumed they were enrolled in Medicare Part D," Tseng said.

"We probably should have asked in the first place."

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