Seniors Do Without Needed Drugs

Monday, March 12th 2001, 12:00 am
By: News On 6

WASHINGTON – On the campaign trail last year, politicians told heart-rending stories of senior citizens forced to choose among food, rent and prescription drugs.

But they pointed to few scientific surveys to prove their point.

A new study, to be published Monday, confirms the anecdotes: Medicare recipients without drug insurance are more likely to go without needed prescriptions than their covered peers. And the gap is growing, says the survey in the medical policy journal Health Affairs.

"We're hearing from the pharmaceutical industry about all the new therapies that are out there to improve people's lives," said Amanda McCloskey, health policy director at Families USA, a consumer group in Washington. "Clearly these folks aren't getting them."

The report found that spending on drugs for seniors without coverage was 45 percent lower in 1998 than for those with insurance, and that the uninsured used nearly a third fewer prescriptions. The disparity was even greater among seniors in poor health and those with chronic health problems, said the report, compiled by government researchers at the Health Care Financing Administration, which runs Medicare.

Senior advocates, politicians and even drug industry officials say the study, based on a random sampling of Medicare beneficiaries interviewed every four months, puts greater pressure on Congress to pass a prescription drug benefit for Medicare beneficiaries.

The extent of the problem has become even more pronounced since the study was done, some experts say, because drug costs have soared. Companies are scaling back their retirement health offerings and passing a greater percentage of the cost along to retirees. In addition, Medicare HMOs have withdrawn from many markets, limiting coverage of prescription drugs where they remain.

"I've been saying for some time that people shouldn't have to choose between putting food on the table and buying the medicine they need," said Sen. Bill Frist, R-Tenn., the Senate's only physician. "This study makes it clear that when low-income seniors are confronted with that choice, they're not getting the necessary medicines to address their illnesses."

President Bush met with congressional leaders last week to discuss ideas to overhaul the Medicare program and add a drug benefit to be administered by private insurance companies. As a stopgap measure, the president wants to give states block grants to provide immediate drug coverage for the neediest seniors.

The new survey "appears to be further evidence that we need to enact prescription drug benefits for our seniors now," said White House spokesman Scott McClellan.

Democrats have criticized Mr. Bush's proposal, saying his tax cut doesn't leave enough money for a new prescription drug benefit. They say any drug benefit must be part of the Medicare program.

Prescription drug coverage "is essential and necessary today," said Sen. Edward Kennedy, D-Mass., at a news conference Friday. "It is as important for our seniors as hospitalization and treatment by doctors."

Mr. Kennedy recalled an elderly couple from Quincy, Mass., who didn't have enough money to pay for heart medicine for both, so decided to share one prescription. "Even though one of them wanted to sacrifice, they made the pact that they were going to take it together so that they were going to die together."

"That shouldn't be happening in this country."

The government publishes annual forecasts of spending on health care by patients, insurance plans and government programs in the journal Health Affairs.

Among the highlights of the latest survey:

• Seniors with drug coverage filled an average 24.4 prescriptions in 1998, up 9 percent from the year before. Medicare enrollees without drug insurance filled 16.7 prescriptions in 1998, down 2.4 percent from the year before.

The gap between the two groups increased from 5.3 prescriptions in 1997 to 7.7.

• Insured seniors received $999 worth of drugs in 1998, but they spent only $325 out of pocket. Seniors without drug coverage received $546 worth of drugs, all paid for out of pocket. The gap in spending increased also, from $329 in 1997 to $453 the following year.

• About 73 percent of the 38 million Medicare enrollees in 1998 had some form of drug coverage, leaving more than 10 million without insurance.

• About half of seniors did not have continuous drug coverage throughout 1996 and 1997. And 20 percent did not have insurance at all during that span.

The study was written by John Poisal and Lauren Murray, both of the Health Care Financing Administration, which administers Medicare. Because the study looked at the whole Medicare program, which covers 39 million people, it included disabled people under age 65.

Officials at Senior Citizens of Greater Dallas said they receive several phone calls each week from seniors seeking assistance with drug costs. Many are enrolled in Medicare HMOs, which place an overall limit on drug coverage and restrict which medicines are covered. Other seniors lack insurance altogether.

Dallas resident Elizabeth Zwaska, 81, said she and her 87-year-old husband, Leonard, spend $350 to $600 every month on drugs. Although she has prescription drug insurance from her former job as a teacher, her husband does not.

"It's a big chunk. It's a big chunk," Mrs. Zwaska said. "If I didn't have my income, just think where we'd be."

Mrs. Zwaska said she is part of the "middle group" – those who earn too much money to receive government assistance but too little to pay for the pills comfortably.

The Zwaskas, who live in the Lakewood area of Dallas, try to conserve utilities and eat out less. Mrs. Zwaska served as a regular substitute at Fannin Elementary School last fall before her husband became ill.

Ms. McCloskey of Families USA said the problem is not getting any better.

"While this [study] paints a pretty grim picture, I think the situation is actually much worse," she said. "It's pretty striking."