Many older adults struggle with high drug costs

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com and other outlets. She is a senior fellow at the Center for Health, Media & Policy at Hunter College in New York City, and co-produces HealthStyles for WBAI-FM/Pacifica Radio.

How can older adults save money on the high cost of prescription medication? It could be as simple as talking to their doctor or pharmacist — but a new survey finds that many aren’t having that conversation, and therefore not getting the help they need to find lower-cost solutions.

More than a quarter of respondents (27 percent) said high drug costs were a problem, yet nearly half (49 percent) said they had not talked with their doctor about the financial burden, according to a University of Michigan Institute for Healthcare Policy and Innovation national poll on healthy aging. High drug costs can keep patients from taking the medications they need to maintain health or prevent complications, according to Preeti Malani, M.D., director of the UM poll and professor of internal medicine, University of Michigan medical school.

“The average 65-year-old is on six different medications, and managed by four or more doctors,” she said in a telephone interview. For these high complexity patients, out-of-pocket costs can pose a financial burden, but nearly half of the survey respondents (49 percent) said they have not discussed costs with their doctors or pharmacists. Among those who did speak up about costs, two-thirds (67 percent) said their physician recommended a less expensive drug and 37 percent said their pharmacist recommended a lower-cost option.

“This suggests that there is an opportunity for physicians and pharmacists to bring up the subject even if their patients don’t,” she said.

One way to help older adults reduce their medication costs is to help them identify and eliminate unnecessary, or low-value, medications, according to Leslie Kernisan, M.D., a geriatrician and clinical Instructor in the division of geriatrics, University of California, San Francisco, who runs a health and caregiving education website. “Countless older adults are taking medications that are not indicated or barely benefit them,” said Kernisan, who was not involved in the UM poll.

“It’s easier for physicians to prescribe than de-prescribe,” she said in a phone interview. While many prescriptions drugs are absolutely vital to maintaining health, for other conditions, there are often non-drug alternatives that are as effective and can avoid many common side effects.

So why not do this more often?

There’s an issue of ownership, according to Malani. Primary physicians are reluctant to stop something another physician started. And, it’s difficult for doctors to keep up with the costs of drugs, due to ever changing formularies and insurance coverage. Most physicians have no idea what prescription drugs really cost the patient.

“Even 50 or 80 dollars a month, multiplied by 12 months, is a lot of money for a lot of people. We’re finding just how vulnerable a lot of people are right now,” Malani said.

Under the Affordable Care Act, Medicare pays for a separate, annual medication review. That could be really helpful, save money, and reduce side effects, Malani said. “A good pharmacist, a good health care provider, can really narrow that list sometimes.”

Other money-saving strategies include using pharmacies in the big box stores like Costco or Target, which offer many common prescriptions for as little as four dollars. The trade off is an additional trip to the store and not having one pharmacist with a complete medication record for the patient if different electronic health systems are used, Kernisan said. Mail order pharmacies associated with the patient’s health plan are another option that can frequently lower the cost of maintenance drugs like statins or anti-hypertensives. There are also discount prescription cards and manufacturer coupons available for many drugs.

“Older people should also bring an advocate with them to their next visit, who is willing to ask questions about costs, if the patient is reluctant to bring it up” Kernisan advised. Just because there is a newer drug available doesn’t mean it’s always the best option. Often an older, generic version works just as effectively at less cost.

Both Malani and Kernisan pointed out that pharmacists are an underutilized resource when it comes to saving money on medication. While pharmacists can’t change prescriptions on their own, they can contact the physician on the patient’s behalf, alert them about cost, and suggest less expensive options. And, some medications are simply not recommended after a certain age.

“One of the messages I have for other physicians is, make sure you ask” said Malani. If someone is having trouble taking their meds because of side effects or complicated dosing or they’re simply too expensive, this is something that should be on the physician’s list.”

The poll was conducted among a nationally representative sample of 2,131 people, split almost equally between those aged 50 to 64 and those age 65 to 80. One in five respondents (19 percent) had “high complexity” of drug management with six or more prescriptions and multiple providers; another 47 percent had “moderate complexity,” with two to five prescriptions and multiple doctors.

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