Whether because of the cost of medicine itself or the insurance required to get it, prescription drugs can be a strain on the budget for anyone.
However, seniors living on a fixed income especially are having a hard time keeping up with ever-increasing drug prices.
According to Mike Evans, vice president of Enterprise Pharmacy and chief pharmacy officer of Geisinger, the cost of pharmaceutical drugs increase by 5 to 15 percent each year.
“They are not getting any easier to afford. When we look at senior citizens, they are relying on social security or a fixed income,” explained Evans. “So as the price continues to grow, it becomes very quickly unaffordable.”
For Joyce Pittenger, of Montoursville, the insulin necessary to fight her diabetes can be prohibitively expensive.
Her Metformin and Glipizide, tablets, taken orally to help treat diabetes, could cost about $50 combined depending on the dosage and number of pills, but are adequately covered by her insurance.
The insulin, Basagalr, which could cost about $250 for a case of five pens according to goodrx.com, is far more expensive than the other two combined and is not as well covered, she said.
Pittenger pays about $70 every five weeks or so for the pens, she said.
“I have to pay quite a lot for my diabetic pen and I have no idea why,” she said. “You have to have that, so that’s something I don’t understand.”
Her own insulin isn’t the only medical cost she pays.
Pittenger’s husband had been quite ill and took 13 to 14 medications daily for some time before he passed away, she said. Paying for those resulted in credit card debt currently surpassing $1,000.
“I haven’t put anything on the card since. I’m still paying on it, and he’s been dead two years,” she said. “But what do you do, you know?”
In addition to the cost of medications, Pittenger’s insurance itself costs over $100 monthly.
She also pays a near-$20 penalty fee due to a misunderstanding which seems to have carried over from her previous insurance, in which she chose her plan at a time before she had regular prescriptions and did not know to switch plans when that changed, she said. When her insurance changed to a new company, she was told she’d have to pay a penalty.
“They take $100-some out per month, out of my (social security) check,” she said. “Then I still have to pay the $20 penalty charge. If I don’t pay that, they will cancel my insurance, and I can’t find out how many years I have to keep paying on this.”
“I’m not alone,” Pittenger added. “I know a lot of people struggling.”
Wilber Cleve Ward, of South Williamsport, is prescribed a handful of medications. But his insulin blows all the rest away in terms of price, he said.
“Insulin is pretty expensive and I have to be careful, very careful, to be able to afford it,” he said. “I have to have the insulin. I’m between a rock and a hard place. It’s more expensive every day it seems, but there’s no choice.”
Ward deals with memory problems and could not recall the price of his insulin, nor how much his insurance covers. But he knows his insurance helps “a great deal, which was the shocking thing to me,” he said.
When his pharmacy once told him the full cost of his medication, he was astounded.
“My goodness, you probably had to pick me up off the floor,” Ward said.
For a retired public school teacher, he said, the expense has been burdensome.
“So far, I’m managing. I’m paying for it, but it’s tight,” he said. “Thank heavens I have the insurance I have. I’m very grateful. I have a deep fear of being in debt.”
For some, the cost of prescriptions doesn’t cause fear for the future, but big problems here in the present.
Rachel Abbott, chief operations and planning officer for STEP Inc., shared a story for a man who recently approached the STEP Office of Aging’s Apprise program after giving up on trying to get his heart medication.
The man had struggled for some time to get his insurance to cover the $200 prescription, for which he was unable to take the generic version, she said.
He had appealed to the insurance company, but was denied twice.
“He gave up and chose not to get his medicine,” Abbott said.
The program not only helped the man get approved for food stamps and cash to help him pay his co-pays, but also helped him switch his insurance to a plan that would cover his medication, she said.
“He called our office and he was over-the-moon happy as he picked up his first prescription that was covered and it cost $3.80,” Abbott said.
Others like this man have been able to use similar community programs or those like Programs of All-Inclusive Care for the Elderly, known as PACE, or Silverscript through Medicare.
In Evans’ time as chief pharmacy officer, he has developed high opinions of the state government programs.
“PACE is from the Pennsylvania lottery, so what they do is they take proceeds from the lottery and those proceeds are used to fund senior citizens for their prescriptions. There is an application and a criteria for the citizens to meet,” said Evans.
Evans added that the major benefit of the program is the wide range of medicines that can be found on the program’s formulary.
“Almost every single medication that is FDA approved is on their formulary, which means they cover it,” explained Evans. “A $6 to $8 copay can be attached depending on the medicine and then PACE picks up the other costs.”
Janet Wolfe, of South Williamsport, has multiple prescriptions including a blood thinner called Eliquis, which could cost about $556 for 60 5-milligram pills, according to goodrx.com.
“I wouldn’t holler, I have PACE,” said Wolfe. “They (PACE) help with a lot. Without them, I’d be up the creek.”
Naomi Johnson, of Williamsport, also uses PACE and her four or five monthly prescriptions only cost about $13 per month thanks to the program.
“If I didn’t have the insurance, I guess I’d be in bad shape,” she said.
Pastor John Aderhold and his wife, Joy, both of Williamsport, use AARP, which “is very affordable” for them, they said.
“But I know a lot of people are hurting,” Joy Aderhold said.
Many seniors who have access to programming and senior centers are more likely to be better off, John Aderhold added.
“We have someone looking out for us, whether it’s (STEP) Office of Aging or whoever,” he said. “It’s those who don’t know about the programs or who don’t have the means to get to them who likely are struggling.”
For those prescribed medications that come at a higher monetary rate, the 340 B program through Geisinger provides financial assistance based on a set of federal criteria.
According to Evans, 340 B is a federal drug program where health systems or hospital systems that meet certain criteria can care for an indigent or at-risk population.
Geisinger has multiple hospital locations that meet the standards and therefore are able to purchase medications at a discounted rate. In turn, the patients receive a discounted rate as well.
“Health systems use 340 B for high-cost medications, infused medications or if a patient is going to an infusion center,” said Evans. “One that might cost like $60,000 a year. In that case, they would be enrolled in the program. We spend a lot of money to run the program, but it is to benefit our patients.”
According to Evans, for those who might not meet the criteria or qualifications for specific programs, the best way to manage costs is to turn back to the prescribers.
“As a prescriber, what we have seen over the years is what I call ‘prescribing momentum.’ We don’t often reset and speak with our providers and think, ‘Okay, you are on these 23 medications’ and go down through and look at those and ask what is the cost benefit,” said Evans.
Cost benefit, as defined by Evans, is when both the patient and prescriber look at both what the patient is paying and how the medication is benefiting the patient clinically.
“You’re now 80 years old and on a cholesterol medication,” he said. “There is a risk of being on the medication … because of the cost benefit, it is doing more harm than good.”
According to Evans, the number of senior citizens who are falling into the category of needing financial assistance in regards to pharmaceutical drugs is increasing as time progresses.
“I feel that our patients should work with their pharmacists to look at their drug profile and review it to make sure it is appropriate and the most affordable,” said Evans. “They legally have to ask us if we would like counseling on the prescription and most times people say ‘no.’ … Our patients could utilize the pharmacists to look and make recommendations and work with clinicians that are more affordable.”