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Prescription Drugs and the Elderly Sumaiya E. Zobairi, MD
Issues <ul><li>As physician’s we feel overwhelmed/ overburdened </li></ul><ul><ul><li>Multiple Chronic Illnesses </li></ul...
The Financial Burden of  Prescription Drugs on the Elderly and the Role of the Primary Care Physician Sumaiya E. Zobairi M...
Objectives <ul><li>To recognize the financial burden of prescription drugs on the elderly </li></ul><ul><li>To comprehend ...
Financial Burden Posed by  Prescription Drugs <ul><li>Anticipated expenditure from 2004-2013:  $1.8 trillion </li></ul><ul...
Financial Burden on the Elderly <ul><li>Only 75%  of community dwelling Medicare beneficiaries have prescription drug cove...
The Dilemma <ul><li>Increasing Cost </li></ul><ul><li>Inability of federal funds to keep up </li></ul><ul><li>Hence, incre...
Reason for Increasing Cost <ul><li>A growing aging population  </li></ul><ul><li>Introduction of new treatments </li></ul>...
The Elderly and Health Disparities: A Closer Look
Seniors with Chronic Health Conditions & Prescription Drugs: Benefits, Wealth and Health <ul><li>Objective :  </li></ul><u...
Financial Disparities in Prescription Drug Use Between Elderly and Non Elderly Americans <ul><li>Objective : </li></ul><ul...
The Family Physician’s Role: Recognizing the financial burden and providing assistance
Identifying Pts Inability to Obtain Prescription Drugs <ul><li>The primary care physician responsibility: </li></ul><ul><u...
Reviewing Prescribing Habits <ul><li>Be cost conscious </li></ul><ul><li>Use drug samples appropriately </li></ul>
Options for Patients <ul><li>Patient Assistant Programs </li></ul><ul><li>State and local programs </li></ul><ul><li>Pharm...
Patient Assistance Programs <ul><li>75 drug companies offer PAP </li></ul><ul><li>800 medications are currently offered </...
Patient Assistance Programs <ul><li>Application access </li></ul><ul><li>Application process </li></ul><ul><li>Eligibility...
State & Local Programs <ul><li>State Sponsored : For Medicare Recipients, Not yet operational / postponed </li></ul><ul><l...
Pharmaceutical Manufacturer Discount Cards Contact &Misc Info Benefit Annual Income Below Prescriptions Covered Program 1-...
Medicare Drug Discount Card <ul><li>Part of Medicare Prescription Drug, Improvement and Modernization Act of 2003 </li></u...
Paradigm Shift <ul><li>Comprehensive healthcare reform should advocate: </li></ul><ul><ul><li>health promotion programs to...
In Closing <ul><li>Resources are available to patients and physicians </li></ul><ul><li>And yet, we are challenged to deve...
References <ul><li>Cundiff David K. Medicare prescription drug benefit realities. Medscape General Medicine. 2003 Dec 10;5...
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  1. 1. Prescription Drugs and the Elderly Sumaiya E. Zobairi, MD
  2. 2. Issues <ul><li>As physician’s we feel overwhelmed/ overburdened </li></ul><ul><ul><li>Multiple Chronic Illnesses </li></ul></ul><ul><ul><li>Poly pharmacy </li></ul></ul><ul><ul><li>Side Effects and Drug Interactions </li></ul></ul><ul><ul><li>Non Compliance </li></ul></ul><ul><li>For elderly patients, prescription drugs represent a overwhelming financial burden </li></ul>
  3. 3. The Financial Burden of Prescription Drugs on the Elderly and the Role of the Primary Care Physician Sumaiya E. Zobairi M.D.
  4. 4. Objectives <ul><li>To recognize the financial burden of prescription drugs on the elderly </li></ul><ul><li>To comprehend the gravity of this issue as it relates to health maintenance </li></ul><ul><li>To effectively address the issue with one’s patients </li></ul>
  5. 5. Financial Burden Posed by Prescription Drugs <ul><li>Anticipated expenditure from 2004-2013: $1.8 trillion </li></ul><ul><li>Allocated budget of only $400 billion </li></ul>
  6. 6. Financial Burden on the Elderly <ul><li>Only 75% of community dwelling Medicare beneficiaries have prescription drug coverage </li></ul><ul><li>Of these only half have continuous coverage over a 1 year period </li></ul>
  7. 7. The Dilemma <ul><li>Increasing Cost </li></ul><ul><li>Inability of federal funds to keep up </li></ul><ul><li>Hence, increasing financial burden on the elderly who can not afford the out of pocket expense </li></ul>
  8. 8. Reason for Increasing Cost <ul><li>A growing aging population </li></ul><ul><li>Introduction of new treatments </li></ul><ul><li>Direct-to-consumer advertising </li></ul>
  9. 9. The Elderly and Health Disparities: A Closer Look
  10. 10. Seniors with Chronic Health Conditions & Prescription Drugs: Benefits, Wealth and Health <ul><li>Objective : </li></ul><ul><ul><li>Examine the relationship btwn prescription benefit status and the access to medications among Medicare beneficiaries </li></ul></ul><ul><li>Results : </li></ul><ul><ul><li>Lacking a prescription benefit was independently associated with difficulty affording medications and consequently coping mechanisms such as splitting pills </li></ul></ul><ul><ul><li>Other coping strategies noted included not filling prescriptions and attempts to obtain medications from Canada through mail order </li></ul></ul>
  11. 11. Financial Disparities in Prescription Drug Use Between Elderly and Non Elderly Americans <ul><li>Objective : </li></ul><ul><ul><li>To examine the cross-sectional disparities in the financial burden of prescription drugs use among US elderly and non elderly populations. Out of pocket spending for prescriptions, co-payment rates and proportion of family income spent on prescription drugs were examined to compare elderly people with working age adults. </li></ul></ul><ul><li>Results : </li></ul><ul><ul><li>Even after utilization or need was adjusted for, financial disparities were still observed between elderly and non elderly adult populations. </li></ul></ul><ul><ul><li>In particular, low income elderly (125-199% of poverty) were worse off than nonelderly adults in the same poverty class and their elderly peers in other poverty classes </li></ul></ul>
  12. 12. The Family Physician’s Role: Recognizing the financial burden and providing assistance
  13. 13. Identifying Pts Inability to Obtain Prescription Drugs <ul><li>The primary care physician responsibility: </li></ul><ul><ul><li>The “3P’s” </li></ul></ul><ul><ul><ul><ul><li>Polite </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Private </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Persistent </li></ul></ul></ul></ul>
  14. 14. Reviewing Prescribing Habits <ul><li>Be cost conscious </li></ul><ul><li>Use drug samples appropriately </li></ul>
  15. 15. Options for Patients <ul><li>Patient Assistant Programs </li></ul><ul><li>State and local programs </li></ul><ul><li>Pharmaceutical Manufacturer Discount Cards </li></ul><ul><li>Medicare Drug Discount Card </li></ul>
  16. 16. Patient Assistance Programs <ul><li>75 drug companies offer PAP </li></ul><ul><li>800 medications are currently offered </li></ul><ul><li>In 2001: PAPs distributed prescription medications with a wholesale value of about $1.5 billion to more than 3.5 million patients </li></ul>
  17. 17. Patient Assistance Programs <ul><li>Application access </li></ul><ul><li>Application process </li></ul><ul><li>Eligibility </li></ul><ul><li>Cost </li></ul><ul><li>Response time </li></ul><ul><li>Deliver of medication </li></ul><ul><li>Amount of Medication </li></ul><ul><li>Refills </li></ul><ul><li>Re-enrollment </li></ul>
  18. 18. State & Local Programs <ul><li>State Sponsored : For Medicare Recipients, Not yet operational / postponed </li></ul><ul><li>Community Health Centers : Health Resource and Services Administration </li></ul><ul><li>Local Area Agencies on Aging : Texas Department of Aging and Disability Services </li></ul>
  19. 19. Pharmaceutical Manufacturer Discount Cards Contact &Misc Info Benefit Annual Income Below Prescriptions Covered Program 1-800-865-7211 www.together-rx.com At participating pharmacies receive a 20-40% savings off the regular prescription price of over 155 medications $28,000/Individual * $38,000/Couple * *Alaska & Hawaii have higher income limits Select drugs Together Rx Card 1-866-974-2273 www.NovartisCarePlan.com At participating pharmacies: A. Pay $12.00/mo . (per Prescription) B. Receive 25% - 40% off Two Income Categories: A. $18,000 /Individual $24,000/Couple B. $28,000/Individual $38,000/Couple Select drugs Novartis Care Card 1-877-795-4559 www.lillyanswers.com At participating pharmacies pay $12.00/prescription for a 30-day supply $18,000/Individual $24,000/Household All drugs except controlled substances LillyAnswers (Eli Lilly & Company 1-888-672-6436 At participating pharmacies receive a 30% average savings $30,000/Individual $40,000/Couple All drugs GAO SmithKline Orange Card
  20. 20. Medicare Drug Discount Card <ul><li>Part of Medicare Prescription Drug, Improvement and Modernization Act of 2003 </li></ul><ul><li>Expectations: </li></ul><ul><ul><li>10-15% discount on total prescription cost </li></ul></ul><ul><ul><li>Enrollment fee $30 </li></ul></ul><ul><ul><li>Covered drugs: most FDA approved drugs, vaccines and biological products and supplies for medication administration </li></ul></ul>
  21. 21. Paradigm Shift <ul><li>Comprehensive healthcare reform should advocate: </li></ul><ul><ul><li>health promotion programs to reduce reliance on drugs </li></ul></ul><ul><ul><li>And then pay, 100% of essential drugs </li></ul></ul>
  22. 22. In Closing <ul><li>Resources are available to patients and physicians </li></ul><ul><li>And yet, we are challenged to develop innovative methods of dealing with this issue, keeping in mind that public policy is so integral to the practice of medicine </li></ul>
  23. 23. References <ul><li>Cundiff David K. Medicare prescription drug benefit realities. Medscape General Medicine. 2003 Dec 10;5(4):28. </li></ul><ul><li>Inglehart, JohnK. Prescription-drug coverage for Medicare beneficiaries. New England Journal of Medicine. 2003 Sep 4;349(10):923-5. </li></ul><ul><li>Montemayor, Karen. How to Help Your Low Income Patients Get Prescription Drugs.Family Practice Management. November/December 2002: 51-56 </li></ul><ul><li>Saver, Barry G.Seniors with chronic health conditions and prescription drugs: benefits, wealth, and health. Value Health. 2004 Mar-Apr;7(2):133-43. </li></ul><ul><li>Steinbrook, Robert.The prescription-drug problem.New England Journal of Medicine. 2002 Mar 14;346(11):790. </li></ul><ul><li>Traynor, Kate. Drug Discount Cards for Medicare Beneficiaries to Debut This Year. Am J Health-Syst Pharm. 2004; 16; 224-225. </li></ul><ul><li>Xu, KT. Financial Disparities in Prescription Drug Use Between Elderly and Non Elderly Americans. Health Affairs, 2003 Sep-Oct; Vol 22 (5), pp210-21 </li></ul>

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