Pay Bills or Pay for Medications?

Newswise — With her prescription drugs totaling more than $550 a month, 70-year-old Virginia Norman often had to choose between taking her medications and paying her bills. Norman is just one of the millions of Americans who can't afford to purchase their necessary medications each month.

Her prescribed diabetes and hypertension medications were the first to be cut, seriously endangering her health. Fortunately, with the help of her physician and social workers at the University of Michigan Health System, Norman has been able to receive advice on private, state and federal drug cost assistance programs that have completely freed her from paying out-of-pocket for her monthly medications.

John Piette, Ph.D., a research scientist with the VA Ann Arbor Healthcare System, and a faculty member with the U-M Health System, has studied the high costs of prescription drugs in the United States and determined that an alarming number of Americans like Norman are cutting back on their medications due to high costs. And many of these patients do not tell their health care providers, which could have a dangerous impact on their health.

"Prescription drug costs are a very big problem for Americans, especially for those who are elderly or have chronic medical problems. Part of the problem is that there are so many new therapeutic agents that work so well," notes Piette. "So, while there are a lot of new drugs out there to keep patients healthy, many patients have difficulty paying for those prescribed medications."

On average, senior patients may need to take five to 10 prescription medications each day, which can be a burden even for people with prescription drug coverage. But for those with inadequate coverage, this burden may force them to make very difficult trade-offs.

Studies have shown that as many as one in five older patients with chronic health problems are cutting back on their medications simply because they cost too much. And of those patients, more than half do not tell their clinician, physician or nurse in advance " and that can be a very serious problem, says Piette.

"Not only does the patient's health suffer when they don't talk with their health care providers about cutting back on drugs, but they're also missing out on real opportunities to get help to find cheaper medications or programs that can assist them with medication costs," he says. "At the same time, doctors may be misinterpreting how well the medication is working, not knowing that the patient simply isn't taking the drug because they are unable to pay for it."

Recently, researchers at the VA Ann Arbor Healthcare System and the U-M Health System have been taking a closer look at the health consequences patients face when they are unable to pay for their prescribed medications, and how health care providers are helping patients get the medication assistance they need.

These studies have shown that when patients cut back on medications, it's their health that pays the ultimate price.

When patients with heart disease forego their medication, even for a brief period of time, they are more likely to have a heart attack, stroke or other serious cardiovascular complication. Likewise, these studies have shown that diabetes patients who cutback on medications due to cost have worse blood sugar control, putting them at an increased risk for kidney damage, vision problems and possibly blindness or amputation.

But patients do not have to put their health at risk to save money on prescribed medications " health care providers and social workers can help.

Health care providers can help patients who are taking name-brand medications by identifying generic drug alternatives to save money. For some treatments, health care providers can assist patients by creating a medication regime that will allow them to split pills to save money.

Plus, health care providers can refer patients with drug cost problems to social workers or other allied health professionals in their health system or in the community. Social workers can help patients find statewide medication cost assistance programs that will work best for them and even help them apply for those programs.

Drug companies, too, have programs to assist patients with prescription drug costs, although these programs are often on a drug-specific basis, and the eligibility criteria and the application process can be quite daunting, says Piette.

"The bottom line is that there are programs out there that can help," says Piette. "The programs operate on a patchwork system with varying eligibility criteria across different areas, which vary from patient to patient. That's why it's so important to work with a professional such as a social worker or pharmacist when seeking assistance through these programs because those people know the most about the system and the best programs available for the individual patient."

And what do these programs mean to Norman and her health?

"It means better health and having more money to take care of some of the other health problems that I have," she says.

For more information about drug cost assistance, visit these Web sites:

UMHS Health Topics: Generic Drugs

http://www.med.umich.edu/1libr/aha/umgener.htm

Medication Information Resources

http://www.med.umich.edu/1toolbar/visinfo/druginfo.htm UMHS Department of Social Work

http://www.med.umich.edu/socialwork/

UMHS Press Release: Patients don't tell doctors about Rx cost problems

http://www.med.umich.edu/opm/newspage/2004/medcost.htm

UMHS Press Release: Diabetes patients skip medications to save money

http://www.med.umich.edu/opm/newspage/2004/diabetes.htm