The journal Health Affairs recently published an article titled “Medication Affordability Gains Following Medicare Part D Are Eroding Among Elderly With Multiple Chronic Conditions.” The article is about changes in and problems with affordable access to medication for all Medicare enrollees who are 65 and over, not just those with chronic conditions. It focuses on two different time periods, 2007 to 2009 and 2009 to 2011. The data shows that while Medicare Part D initially improved access to affordable medication, some of those gains were lost, and for seniors taking the most medications, the most vulnerable, improvements may have disappeared entirely.
In 2005, before Part D plans were available, the study noted that an estimated 14.9% of seniors experienced cost-related problems accessing prescription drugs (meaning they did not take medicine as prescribed due to cost), also called cost-related prescription non-adherence (CRN). CRN decreased to 11.3% in 2007. Then, surprisingly, following the worst economic downturn since the Great Depression (during which the average wealth of the elderly dropped 20%), the number decreased further to 10.2%.
During the economic upturn, however, the CRN figures crept back up to 10.8 by 2011. The same trend – a decline then an increase – happened for the percent of seniors forgoing other needs to pay for medicine (such as food and heat): 8.8 percent in 2005, 5.6% in 2007, 4.0%, but back up to 5.3% in 2011.
The CRN numbers are much worse for seniors with four or more chronic conditions, such as diabetes, cancer, hypertension, and asthma, among others, representing about 27% of all beneficiaries. The cost-related prescription non-adherence figures for this most vulnerable group are as follows: 2005 – 21%, 2007 – 15.1%, 2009 – 14.4%, 2011 – 17%.
Why were seniors having more problems with cost in 2011 than in 2009? Clearly the effects of the recession are one reason. For instance, during this period seniors had higher rates of mortgage delinquency and there were no cost of living adjustments to Social Security. Times were (and remain) tough!
But Medicare Part D plan designs are also to blame. During this period, premiums and co-payments increased, more plans charged deductibles, and there were more restrictions on access, such as prior authorization, which often means that people cannot obtain medications prescribed by their healthcare practitioners.
The fact is that despite all its problems, Medicare Part D has made medication more affordable for our seniors. Still, millions of elderly Americans remain vulnerable to high drug prices, and too many are not taking their meds! These costs explain why many seniors buy medication from international online pharmacies.
Unfortunately, the study doesn’t look at numbers for the most recent two years. There may have been improvements. The donut hole continues to close, and there are more generic drugs, which are much cheaper, on the market than there were in 2011. There was also a cost of living adjustment to Social Security in 2014, which can help many beneficiaries more easily afford their meds.
On the other hand, drug plans are introducing new barriers to medicine. The new barriers include replacing traditional co-pays with fixed percentage payments called co-insurance; raising deductibles and premiums; and the removal of drugs from formularies. Beneficiaries who are prescribed multiple medications are more likely to find their out-of-pocket costs increasing due to co-insurance or lack of coverage compared to beneficiaries with fewer conditions.
On our site, MedicareDrugPlans.com, which shows you basic cost and coverage information about Part D plans, and provides consumer ratings and reviews of the plans, we find that people are frustrated because plans do not cover the drugs that they need, require prior authorization, and problems with customer service representatives. Below we’ve published the last two plan reviews, which aren’t so hot.
AARP MedicareRx Preferred . Fed Up writes: “This is by far the worst plan I have ever had. They charge one person more than another even though they have the same plan and the same medication and dosage. I went into the donut hole and just when I was supposed to go into catastrophic coverage they zeroed everything out and said I had to start all over again. The pharmacy had a record of everything I had spent to date but United Healthcare showed that I had spent nothing and was starting from zero. They also cancel my prescriptions before they have expired and keep making me get new prescriptions. Their record keeping is terrible and their Customer service is worse. I can’t wait until open enrollment so I can switch from this nightmare of a plan.”
Express Scripts Medicare – Choice. Anonymousva writes “Awful! Why does a drug I have been taking for 10 years suddenly require “authorization” from my doctor? Isn’t the doctor’s prescription the same as authorization? I’m going back to getting my scripts at the drugstore with written script in hand. This mail order business is a huge time waster and seems to try to throw up every obstacle possible to delivering your Rxs.”
The fact is that most, but not all, consumer ratings and reviews are pretty bad on MedicareDrugPlans.com, but people tend to go online to rate something when they’re not happy about it. We’d like to hear from more Medicare enrollees who like their plans! Rating and reviewing part D plans that you like can help your peers find better plans.Tagged with: cost-related non-adherence, CRN, Health Affairs