In her 35-year nursing career, Joyce Olson would never have considered letting a patient skip a pill.
But the 70-year-old Omahan skimped on her own medicine last fall. The cost grew too high because of a coverage gap in the government's drug program for senior citizens.
Closing that gap is considered one of the key improvements for consumers in the new federal health care law.
“This is going to bring real relief,” said Nora Super, an official with AARP in Washington, D.C.
The gap affects an estimated 40,000 Nebraskans and 60,000 Iowans annually. Individuals can rack up hundreds of dollars in drug costs, a problem aggravated by rising drug prices.
Ultimately, if senior citizens can't afford their medicine, they may skip or split pills, wait longer to get prescriptions refilled or stop taking their drugs entirely. And they often don't tell their doctors.
The results can be dangerous. Cutting back on blood pressure medicine can lead to a heart attack or stroke. Reducing a diabetes drug can cause dehydration, weakness and hospitalization.
While the new health care law isn't perfect for senior citizens, advocates for the elderly say much of it will help, including closing the drug coverage gap.
Known as the “doughnut hole,” the gap has been a source of complaints since the Medicare Part D drug program started four years ago.
People pay monthly premiums and a maximum 25 percent of their drug costs, with the program covering the rest until senior citizens hit the gap.
That happens after total drug costs reach $2,830 for the year. Then senior citizens begin paying 100 percent of their drug bill until their total out-of-pocket costs hit $4,550. After reaching that threshold, they pay a maximum of 5 percent for the rest of the year.
Congress structured the program that way because of a lack of funding when it began.
Drug company discounts, plus an estimated $42.6 billion from the federal government, will close the gap.
Olson said that when she gets together with friends, it's a big topic.
“That's all we talk about,'' she said.
Olson suffers from colitis, a chronic intestinal condition that causes abdominal aches, cramping and other problems. She takes 13 pills a day for the condition.
During the four months she was in the gap last year, her out-of-pocket drug costs reached $650. That's more than double what her costs were in a typical four-month period.
The bigger bill meant she had less to set aside for savings, and for other things she likes to do such as buy Christmas presents for her grandchildren.
About a month after she reached the coverage gap, she cut back to nine pills a day. Even though Olson didn't notice her condition worsening, “I know I wasn't getting any better,'' she said.
The new health care law this year will start addressing the gap by providing a $250 rebate to people who hit it. Next year the government will begin reducing the percentage that people in the gap pay toward drug costs. The law will eliminate the gap by 2020.
Dr. Erin Cooper of the University of Nebraska Medical Center said the gap causes problems for her patients.
Cooper said one of her patients, a woman in her 80s, cut back on her medication for emphysema, a lung condition. The woman's family didn't realize she was skimping until they noticed that her shortness of breath had grown worse. The family began helping the woman pay for the drugs.
Cooper remembers another patient, a man in his 70s with dementia, who could have benefited from a new medication to battle memory loss. The man and his family decided that the medication, which would have cost him $200 per month out of pocket, was unaffordable.
Similar drug costs are not unusual for senior citizens.
A popular brand-name drug for high cholesterol can cost more than $100 per month out of pocket. A common glaucoma drug can reach $150 monthly, and one for diabetes can hit more than $200.
Olson said the rebate she'll get if she hits the coverage gap this year will be a nice boost, and she knows just where she'll put it: her savings account.
Contact the writer:
444-1122, michael.oconnor@owh.com
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