What happens when
the money runs out?Medicare patients face the
threat of increased out-of-pocket
expenses within a few months
One out of four Medicare patients runs out of drug coverage in managed-care plans about three months before the year ends, a study says.
Prices rising
According to a report by Families USA, a national organization for health care consumers, these drugs that experienced the fastest-growing price increases compared with the rate of inflation in the past year:>> Claritin, an antihistamine, went up nearly 12 times the rate of inflation.
>> Klor-Con 10, a potassium replacement, rose more than 11 times.
>> Miacalcin, an osteoporosis treatment, rose more than 10 times.
>> Premarin, an estrogen replacement, increased nearly 10 times.
>> Atenolol, a generic beta-blocker, went up more than nine times.
>> Toprol XL, a beta blocker, rose more than nine times.The report also listed the following brand-name drugs as those most frequently prescribed to seniors:
>> Lipitor, $871 a year
>> Norvasc, $549 a year
>> Fosamax, $894 a year
>> Plavix, $1,539 a year
>> Prilosec, $1,684 a year
>> Celebrex, $2,102 a year
"When they run out, their costs for medication could potentially go up two to three times, which they pay themselves," said Dr. Chien-Wen Tseng, University of Hawaii assistant professor in the Department of Family Practice & Community Health and Pacific Health Research Institute researcher.
Tseng worked on the study of more than 400,000 Medicare members with University of California-Los Angeles and RAND investigators while she was a UCLA Robert Wood Johnson Clinical Scholar.
The team reviewed pharmacy claims from 2001 for patients enrolled in Medicare managed-care plans with an annual cap on drug benefits. Managed care is a system of health insurance with a network of health providers contracted to provide benefits to a certain population for a fixed payment.
The study, published yesterday in the Journal of the American Medical Association, showed 15 of the top 20 medications with the highest total prescription costs were for chronic conditions.
Among them: diabetes, cardiovascular disease, high cholesterol, osteoporosis, dementia, stroke prevention and asthma-emphysema.
Even a short delay in obtaining these drugs due to lack of drug coverage could lead to adverse health effects, the researchers said.
They noted that one-third of the top 20 medications had generic equivalents, which they said are generally much cheaper and could help extend a patient's drug benefits.
The study found that 22 percent of patients with a $750 drug limit exceeded benefits before the end of the year; 14 percent exceeded a $1,000 cap; and 4 percent went over a $2,000 cap.
More than 6 million, or 15 percent of Medicare beneficiaries nationally, are enrolled in Medicare managed-care plans, according to the study. Drug benefits are offered with a cap on the plan's share of costs.
After exceeding the limits, patients' out-of-pocket costs increased to $179 to $305 per month, the study found.
Prices of the 50 most prescribed drugs for senior citizens also climbed an average of nearly 3 1/2 times the rate of inflation last year, Families USA, a national organization for health care consumers, reported yesterday.
"These alarming price increases continue to eat away at the fixed incomes of senior citizens, especially those low-income seniors who make up one-third of those in Medicare and who can least afford to pay for their medicines," said Ron Pollack, Families USA executive director.
Tseng said: "Drugs are not really free even if health plans are paying for them. We'll pay for them through insurance premiums and taxpayers' money. Benefits have to be limited in some way to be affordable."
The only way to keep medications affordable for everyone, she said, is "to be very good consumers and think about the cost and benefit of each medication."
Ideally, people should not have to choose between medications they need because of the costs, she said, adding that the real choices should be between expensive, brand-name medications and lower-cost generic equivalents.
Federal Drug Administration studies have shown the generic version of most medications is just as good as the more expensive brands, with a few exceptions, she said.
This is an important issue in Hawaii, where nearly 204,000 residents, or 20 percent of the population, are believed to have no drug benefits, Tseng pointed out.
She said the Hawaii Medical Service Association and Kaiser Permanente, the state's largest health plans, have reported doubling of drug costs for members in the past five years. They expect costs to double again in five years.
Hawaii also spent more than $62 million on prescription drugs for 35,000 members of the fee-for-service Medicaid program, she said.
Doctors are knowledgeable about which medications are effective, but studies show they are not always aware of the costs of drugs, especially when patients are insured, Tseng said.
She said training of family physicians in the UH John A. Burns School of Medicine offers an opportunity to teach them "to talk sensitively to patients about costs, to be sure patients can afford the medications we're prescribing and help patients make the best choice possible."
