Like monthly utility bills, prescription drug costs for seniors tend to mount up because they are regular expenses. Whether one lives in an assisted living facility, or is simply considering their options to save costs as they grow older, there are a number of state, federal and even private options to help offset the costs of prescription drug plans. The overwhelming majority are tied to income levels, so keep this in mind as you review your options.
Federal Prescription Drug Assistance Programs
An extension of the Medicare program enables those seniors who find it difficult to pay for prescription drug coverage to receive assistance. In this case, generics will not cost more than $2.50, and brand name drugs more than $6.30 per refill. Note that income levels have to be below $16,245, with retirement investments below $12,510, with slightly more for married couples. Many seniors may not require Medicare prescription drug plans, but it is simpler in terms of paperwork because it is already tied to the Medicare program.
It also ties into state Medicaid programs, so that if you receive government assistance for Medicare Part B premiums, you also are automatically entered into this one. Specifically, there are four Medicare savings programs, with income levels ranging from roughly $900 per month to $1,239 that will pay for some deductibles. Individuals who qualify for these programs may also qualify for assistance at the federal level with Part D costs and prescription drug benefits, in some cases up to 95 percent of the cost of prescription drugs. Contacting the Centers for Medicare and Medicaid services
State Prescription Drug Assistance Programs
State prescription drug assistance programs are the backbone of the entire category of senior assistance. Rules and regulations vary from state to state, but are generally closely tied to eligibility requirements for Medicaid. This means that senior citizens who are eligible for state prescription drug assistance will likely make little income, since Medicaid requirements are established just slightly above the Social Security benefit.
This means that most programs simply cover the cost of Medicare Part D, which will continue to have a donut hole of coverage gaps between roughly $3,000 and $7,000. However, those seniors considering the program but who have higher income also have a second option unrelated to the Medicare or Medicaid programs.
These are the discount prescription card programs offered by states such as Michigan that are eligible to all state residents regardless of age or health. With income levels generally below $30,000, these are available to seniors who may not wish to participate in Medicare Part D and provide dicounts ranging from roughly 20 to 30 percent off of prescrption costs. That may not be significant for brand name drugs, but is of value for those who principally take generic medications.
For more information on senior-specific prescription drug assistance programs in your state, visit the maps available here: http://www.ncsl.org/default.aspx?tabid=14334
Private Prescription Drug Assistance Programs
Private prescription drug assistance can take on many forms, ranging from those available from pharmacies or chain superstores that contain pharmacies, to those that are directly connected to pharmaceutical companies. It is difficult to outline just how many different options there are because there are so many. Many pharmaceutical firms offer specialized programs for each of their drugs on offer in the United States, meaning that just one Pfizer or AztraZeneca or BristolMyersSquib could have more than a dozen programs.
One umbrella organization that covers many of these options is the umbrella organization the Partnership for Prescription Assistance, available by calling 1-888-4PPA-NOW. The group claims that they do not charge for their work in pointing seniors to discount services. Keep this in mind: you should not have to pay for help finding prescription drug programs. Some state and federal programs should have enrollment costs, but private options are generally low- or no-cost.
The major difficulty arises with the number of programs, so any senior taking a set of medications should look for options for each one of their medications, and compare them to the discounts offered by state and federal programs. The best fit is the one that makes life easiest, both financially nad in terms of paperwork.
Financial Concerns for Senior Citizens
The major factor in prescription drug assistance programs is the financial limits that they may impose on seniors. Unlike Medicare Part A, Part B and even privately offered Part D prescription drug plans, these options are generally provided for seniors who have run into financial difficulties. They are a godsend for those who may not otherwise be able to pay the out-of-pocket costs, of course. And there are a variety of programs available for seniors who have various retirement investments or income streams, including pensions, IRAs and other such devices.
But seniors who are not living at home, or those who may not be in need of a skilled nursing facility, will likely not benefit greatly from these programs. Considering that the average cost of home healthcare aides or assisted living facility rent and aide bills run roughly $2,000 or so in the best of situations, many state and federal income levels for assistance simply aren’t sustainable for those in these middle stages.
Prescription Drug Assistance Programs and Assisted Living
Prescription drug assistance plans administered by government agencies can make it somewhat difficult for seniors to also consider assisted living facilities. Since income thresholds are so low, there may not be much in the way of disposal income to pay for monthly rent and assistance costs. There are long-term financial solutions, usually involving gifts to adult children and other movements of income. However, the margin between where many government programs are effective in providing prescription drug assistance and the minimum cut offs for enjoying life in an assisted living facility make it difficult to consider all but private options.
Private options may be much more palatable. One example is AstraZeneca’s program for those seniors who are already enrolled in Medicare Part D. For households with incomes of less than $40,000, or individuals of less than $30,000, this can enable someone to pay for most of their assisted living costs but still be able to receive some sort of assistance. It is these programs that most likely are the best fit for those who can afford assisted living facilities costs.
Common Sense Solutions for Lower Prescription Drug Costs
Regardless of your income level, eligibility for various programs or the other number of factors, there are several things that you can do in order to reduce your monthly prescription drug bills. The first is to find out whether or not the drugs you take have generic versions available. While there may be some differences in side effects and the results of some generics compared to brand name drugs in their class, in many cases there are generic versions of the same drugs you are taking now. That means that there is the same active ingredient, just no extra cost for the brand on the box.
The time that a drug has been on the market also plays a key role in its cost. Patents mean that drugs are not available in generic form for more than a dozen years after their launch. However, if you do not see commercials for a drug, that’s likely because it is no longer the “new and improved” version. It may still be a good fit for you, and even though it’s a brand-name drug, it will likely be less costly.
Finally, while it may seem weird to not travel to the local pharmacy in order to receive your prescriptions, mail-order pharmacies do have less overhead costs than comparable brick-and-mortar institutions. You may be calling your pharmacist for concerns about interactions rather than visiting in a local establishment, however. Keep in mind that as your mobility decreases, this may actually turn into a benefit if you can no longer drive frequently at all.
While some seniors also consider mail-order pharmacies and facilities in countries like Canada or Mexico because of the substantial cost differences, this may not be legal in your jurisdiction. More importantly, the drugs may be slightly different due to regulatory disparities in various countries. If you do consider this option, be sure to consult a lawyer or other counsel. Assistedlivingfacilities.org does not endorse or condone this option.
Sources:
http://www.medicare.gov/navigation/medicare-basics/medical-and-drug-costs.aspx
http://www.dhs.wisconsin.gov/seniorcare/information.htm
http://www.dhs.state.or.us/policy/healthplan/guides/seniorrx/main.html
http://www.ncsl.org/default.aspx?tabid=14334
http://www.cms.gov/PrescriptionDrugCovGenIn/03_Resources.asp
http://www.miamidade.gov/senioradvocate/library/RxAsst.pdf
http://www.medicare.gov/navigation/medicare-basics/medicare-benefits/part-d.aspx
http://www.pparx.org/sites/default/files/PPA_brochure.pdf
http://www.dhs.wisconsin.gov/seniorcare/factsheets/p10083.htm
http://www.dhs.state.or.us/policy/healthplan/guides/seniorrx/spdap-supp1208.pdf
http://www.michigan.gov/mdch/0,1607,7-132-8347-100965–,00.html
