Help at hand for poor patients' Medicare prescription drug costs

Washington -- Physicians participating in recent focus groups on the Medicare drug benefit, for the most part, were unaware that their poorest patients might be eligible for additional government subsidies that could save those patients thousands of dollars each year.

The 13 focus groups featured physicians, beneficiaries and pharmacists. They were held last July and October in Richmond, Va.; Portland, Maine; and Denver. The Medicare Payment Advisory Commission hired the National Opinion Research Center at the University of Chicago to conduct the meetings. MedPAC delivered the report with the findings to Congress last month.

"Physicians generally do not know about the low-income subsidy for Part D or other help that is available for Medicare premiums and cost sharing," the researchers stated in the report. They noted that more pharmacists knew the extra help existed, but many did not bring up the income issue with Medicare customers because the pharmacists feared offending them.

Although the report is largely anecdotal, AARP Senior Legislative Representative Paul Cotton said it pointed to a very serious need to educate more doctors about the subsidies and to get physicians to start speaking about them with more patients. Patients in general say they have a high level of trust in their physicians, and doctors can use that trust to find "teachable moments" about this issue during office visits, he said.

"Considering the high cost of prescription drugs today, it's not unreasonable to expect physicians to ask everybody whether they can afford the pills," he said. Physicians who find out some of their patients aren't taking their drugs might want to inquire if the price tag is the reason.

AARP's officers realize that doctors already have many demands on their time and say that these teachable moments need not take up too much time. Physicians who find that some of their Medicare patients may be eligible for subsidies can direct them to the appropriate State Health Insurance Assistance Program, which can take over and walk patients through what they need to do.

AARP has a tool on its Web site to help patients determine available help (link). The Centers for Medicare & Medicaid Services Web site has an outreach tool kit with downloadable assistance information that doctors can print out for patients.

The American Medical Association, AARP and other organizations also provide patient resources through the Access to Benefits Coalition (link).

In a January report, the Dept. of Health and Human Services estimated that 2.6 million enrollees are eligible for the subsidies but are not receiving them. The AARP's Cotton said that given Congress' decision to base eligibility in part on beneficiaries' assets, in addition to their income, that figure could be 4 million or more.

The AARP is making a big push to have Congress raise the asset eligibility limit, with the long-term goal of eliminating it altogether. The organization asserts that some of the most vulnerable patients are just over the threshold and are struggling to pay their drug bills.

One such patient is 87-year-old Charlotte Wachdorf from Hillsboro, Ore., whose daughter, Judy Korynasz, testified May 22 before the U.S. Senate Special Committee on Aging to urge lawmakers to raise the limit. Her mother, who has multiple chronic conditions, has an annual income of only about $12,000 but has more than $15,000 in savings, putting her several thousand dollars over the asset cutoff. Congress could fix the problem by raising the limit, she said.

"She would not have to spend most of her income and the little savings she has on prescription drugs," Korynasz said.