Prescription for Savings
According to the Kaiser Family Foundation, 20% of people 65 or older say they have difficulty paying for their prescription medications, and a third say they don’t take all their medicine because of the expense.
Reports say some spend an average of 3% of their income on prescription drugs, a number that increases when including over-the-counter medications, which can be a major challenge for those with fixed incomes.
Brandi Schneider is the director of aging and administrative services at Springdale’s Schmieding Center, part of the UAMS Centers on Aging. She said a patient doesn’t necessarily have to accept a prescription’s sticker price.
“I would say, before they stop taking a medication or think they can’t afford a medication, to talk to their doctor or their pharmacist and see if there’s maybe a similar medication that is less expensive,” Schneider said. “Sometimes doctors get in the rut of prescribing a certain medication or brand name that’s most common.”
There are three primary ways seniors and their caregivers can cut the cost of medications.
Insurance prescription benefits include an understanding of what options exist with Medicare, Medicaid or Medicare supplemental insurance.
Financial assistance programs help pay for medication or insurance premiums, co-pays and deductibles.
Low-cost options are often overlooked, but there are a variety of ways to find discounts and more affordable versions of medications.
Prescription drugs are covered by Medicare Part D (though more than 65% of those enrolled reportedly pay 65% of their costs out of pocket), through Medicare Prescription Drug Plans (PDPs) or as part of a Medicare Advantage Plan (MAPD).
Schneider said seniors should review their insurance plans each year to make sure none of their medications have been dropped.
“As those drug plans change, those expensive medications may not be covered,” Schneider said. “They need to make sure they’re checking every year to see that everything they’re taking is covered. I start getting calls every January.”
Extra Help, available in Arkansas, is a Medicare financial assistance program available to seniors whose total assets (minus residence, vehicle and personal items) are valued at less than $15,510 for individuals or $30,950 for married couples. Income limits in 2022 were $20,385 (single applicant) and $27,465 (married couple).
Low-income and disabled people can qualify for state-run Medicaid insurance plans with co-payments ranging from 50 cents to around $8, with a limit of two to six prescriptions per month. In most states in 2022, the monthly income limit for seniors was less than $2,523 with assets (minus the home) valued at less than $2,000.
The launch of the Affordable Care Act and the closing of the “Donut Hole” for brand name and generic drugs has led to the closing of several state-based Medicare Wraparound Programs. Arkansas does not have such a program.
Patient Assistance Programs (PAPs) are run by almost all the major pharmaceutical companies and help provide reduced-cost or free medication to low-income people. Proof of income, like a tax return, is normally required, along with a prescription and any existing insurance documentation.
“There are some patient assistance programs, usually through the drug manufacturers,” Schneider said. “Rxassist.org or needymeds.org are a couple places you can look for some manufacturer discount programs that can help if you’re taking a more expensive medication. I always say ask your pharmacist, too. … They’re great about searching through the databases and finding discounts.”
Caregivers and seniors who do a little digging can take advantage of coupons, offered by many pharmaceutical companies, which can often reduce the cost of a brand-name drug to the price of its generic equivalent.
Drug discount cards are accepted by most major pharmacies and can help reduce prescription costs by as much as 80%.
The Medical and Dental Expense Tax Deduction makes some out-of-pocket prescription costs tax deductible if the sum of medical and dental expenses is greater than 7.5% of an individual’s adjusted gross income. Because of fixed incomes, seniors commonly meet the 7.5% threshold, and the deduction allows a broad range of medical and dental expenses.
Swapping brand names for generic drugs can reduce costs anywhere from 25%-75%.
Insurance companies allow seniors to receive a larger quantity of their medicines if they use a mail-order pharmacy. A $20 retail pharmacy co-pay that provides a 30-day quantity of a medication could equate to a 90-day supply for the same co-pay through the mail-order option.
Canadian pharmacies offer drastically lower prices for some drugs, with up to 50% less for brand-name drugs and 25% less for generic ones. In most cases, the Federal Food, Drug & Cosmetic Act bars people from importing drugs from other countries, and the National Association of Boards of Pharmacy warns that online pharmacies claiming to offer Canadian drugs can be unsafe.
However, the FDA doesn’t object to individuals importing drugs from Canada under certain specific and limited circumstances, such as when no effective treatment is available in the U.S. or the drug is not available here.