With Congress and the Trump administration targeting Medicare, Medicaid and Social Security with budget cuts, seniors may face reduced access to Medicare Part D, the prescription drug program.
Seniors may find difficulty in obtaining help with paying for their prescription drugs if Medicare Part D’s myriad programs face the same fate as Medicare Part A, B and C.
Part D includes its Medicare Extra Help drug assistance programs, State Pharmaceutical Assistance Programs, also known as SPAPs, and Pharmaceutical Assistance Programs, also known as PAPs.
Access issues could worsen if the Trump administration and conservative House and Senate lawmakers pass a budget that would cut Medicare, Medicaid and Social Security benefits and, in turn, prescription drug coverage.
Controlling Drug Costs
To rein in drug costs, seniors have a number of options open to them to effect financial savings even before they approach Medicare Extra Help drug assistance programs and SPAPs.
They may review the prescription drug coverage they already have, including their plans from an employer, a trade union, TRICARE, the Department of Veteran Affairs, also known as the VA, the Indian Health Service, or a Medicare Supplement Insurance (Medigap) policy before they seek additional assistance.
Aging patients tend to inform their primary care, family practice and internal medicine physicians or medical specialists about their concerns over the price of their medications and are urged to continue to do so. Doctors may not know about their drug costs but they can tell them about less costly alternatives.
Seniors can also request senior citizen’s discounts from pharmacies. They can shop around, comparing prices at different stores or pharmacies.
Often times, however, lower drug costs may not have value if seniors need other services such as home delivery, patient medicine profiles, pharmacist consultation or if they cannot obtain senior discounts.
Mature patients may be interested in medicine samples. They can ask their doctors providing prescriptions for new medication to give them samples they can try before filling them. This practice enables them to try out drugs before they spend benefits on them.
Seniors can also buy bulk. They can secure a large volume of medicine for a reduced price if they need the medication for a long period of time and the expiration dates are not immediate.
Additionally, they can seek out mail-order services. Mail-order pharmacies are able to provide drugs at minimal cost, saving them benefits and money.
They can also purchase over-the-counter medicines during a sale as another means of making savings. To do so, seniors would need to inspect the expiration dates and use the drugs they buy before they run out.
Medicare Extra Help, SPAPs, PAPs
If consulting other drug programs such as VA or Tricare, approaching their doctors, obtaining senior discounts, sampling drugs, buying medicine in bulk, trying mail-order services and buying over-the-counter medications on sale still does not lead to savings, seniors may turn to Medicare Extra Help programs, SPAPs and PAPs.
Medicare Extra Help program is the Social Security drug assistance program and application process for the Medicare Part D drug subsidy. The program’s requirements and policy can be found at Social Security website at http://www.ssa.gov/prescriptionhelp.
SPAPs are state-funded drug assistance programs to control prescription drug costs. They are offered in at least 23 states and one U.S. territory with some type of coverage to help seniors with paying drug plan premiums, cost sharing or both. The program’s directive are located at the Medicare website at http://www.medicare.gov/spap.asp.
Similarly, PAPs are programs offered by commercial pharmaceutical companies that assist patients with the costs of drugs they manufacture. Rules and conditions of participation can be found at the Medicare website at http://www.medicare.gov/pap
Seniors who are already enrolled in Original Medicare Part A and B and Medicare Part D for prescription drugs may also obtain Medicare Extra Help for at least a year if their medication costs surpass the scope of three parts of the program.
Under Medicare Extra, they pay a small co-payment or no co-payment once they reach what is known as the coverage gap or the “donut hole” or catastrophic coverage. Through the coverage gap, seniors receive a 50 percent discount on covered brand-name medicines and some for generic drugs.
Often times, Medicare beneficiaries may already be enrolled in Medicaid, Medicare Savings Program and Supplemental Security Income, also known as SSI, and may not have to qualify or apply to take part.
Some members may also have Social Security withhold their entire monthly premiums because a SPAP or employer health plans pays part of their drug plan premiums.
If seniors must apply to determine if they qualify, certain types of income must be included on their application forms to be considered by the Social Security Administration.
Eligible income categories include wages, earnings from self-employment, Social Security benefits, Railroad Retirement benefits, veterans’ benefits, pensions, annuities, alimony, rental income and worker’s compensation.
Certain resources also count such as cash at home, accounts at banks such as savings, money markets, time deposits or certificates of deposit, individual retirement accounts or 401(k) accounts, stocks and bonds, savings bonds, mutual fund shares, promissory notes or real estate outside of the home.
Additional Federal, State, Commercial Choices
Additionally, seniors can consult with community experts through their local branches of the federal National Association of Area Agencies on Aging, also known as AAA or (n4a), or State Health Insurance Assistance Program, also known as SHIP, who will walk them through comparing and selecting the best prescription drug plans.
To enable seniors to receive assistance with prescription drug plans through AAA or n4a, Medicare works with government agents, community and faith-based groups, employers, unions, doctors pharmacies and nonprofits.
The experts are trained and volunteer staff and the program is one several services offered by the federal agency Administration on Aging, also known as AoA, and administered by the AAA or n4a. Rules and policy for this assistance can be found at the AAA or n4a website at http://www.eldercare.gov.
Sometimes, through AAA or n4a, seniors may come into contact with national and community-based programs such groups as the National Patient Advocate Foundation or the National Organization for Rare Disorders that manage programs that can help them lower their drug costs.
The Consumer Union, the publisher of Consumer Reports, also offers a public education project called Consumer Reports Best Buy Drugs, also known as CRBBD, to instruct seniors to compare the safety, effectiveness and costs of a variety of prescription drugs.
The emphasis falls especially on how certain drugs treat diseases as compared with other medications. Seniors can access reports and information to make comparisons at the Consumer Union’s website at http://www.CRBestBuyDrugs.org
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- Administration on Aging of the U.S. Department of Health and Human Services, http://www.aoa.gov
- Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, http://ahrq.gov
- Consumer Reports Best Buy Drugs (CRBBD), public education project of the Consumers Union, http://consumerreports.org/health/medication/tracker/index.htm or http://www.CRBestBuyDrugs.org.
- Council on Family Health, Brochure: “Medicines and You: A Guide for Older Adults,” http://www.cfhinfo.org.
- Food and Drug Administration of the U.S. Department of Health and Human Services, http://fda.gov
- Medicare prescription drug coverage, visit medicare.gov/find-a-plan
- Medicare Extra Help Program via Social Security, http://ssa.gov/prescriptionhelp.
- National Association of Boards of Pharmacy, http://nabp.net
- National Council on Patient Information and Education, http://talkaboutrx.org.
- National Institute on Aging Information Center, http://niapublications.org
- National Institutes of Health, http://nihseniorhealth.gov
- National Library of Medicine, “Drug Information” section, http://medlineplus.gov
- Pharmaceutical Assistance Programs (PAP), http://medicare.gov/pap
- State Pharmaceutical Assistance Programs (SPAP), http://medicare.gov/spap.asp
- Substance Abuse and Mental Health Services Administration, http://findtreatment.samhsa.gov
- Transportation Security Administration (TSA) of the U.S. Department of Homeland Security, (information about travel with medicines), http://tsa.gov
- United States Office of Personnel Management, opm.gov/insure/health/.