Help for seniors
Call the Jayhawk Area Agency on Aging at 235-1367, Healthwise 55 at Stormont-Vail HealthCare at 354-6787 and Topeka LULAC Senior Center, 234-5809.
Bitter pills
BITTER "I try to take care of myself, but every time I go to the doctor,
(I think) 'I hope you don't give me any more pills.' "
--- 68-year-old Juanita G. Razo on the cost of perscription drugs
By LISA M. SODDERS Photographs by GREG LAHANN The Capital- Journal
Drug costs are stretching many senior citizens' fixed incomes to the breaking point
hen 84-year-old Victor Perez's leg became infected, he had a serious problem.
It wasn't that the swelling and redness couldn't be treated; the challenge came with how the Topeka man was going to pay for the antibiotics his doctor had prescribed.
At one Topeka pharmacy, the cost would have been $240 for a 30- day supply. The same prescription was at another store for $20 less, but that didn't help much when Perez lives on $1,100 a month.
This time, the doctor solved the problem with free samples. At least for now, the prescription won't have to be filled.
Every time 68-year-old Juanita G. Razo goes to the doctor, she is afraid he might prescribe her another pill.
She has lost both legs above the knee to complications from Type II diabetes, and she estimates she takes 11 different pills each day - -- some for her heart, some for her kidneys, another to keep water off her heart.
Last year, she spent about $1,700 on medicine, but her monthly income is $1,800, and she has family members living with her.
"Even though I'm doing OK, you never know," Razo said. "I try to take care of myself, but every time I go to the doctor, (I think) 'I hope you don't give me any more pills.' "
The average elderly person in the United States takes eight prescription medicines each day. The cost of that medicine can be mind boggling. If the elderly person is lucky enough to have supplemental insurance, the premium for that also can be expensive. Perez pays $250 a month on his extra insurance policy.
Perez, who lives in a government-subsidized apartment complex, is one of Topeka's luckier senior citizens. Despite his health problems, he leads a fairly active life and has family and friends around him. For the most part, his medical expenses are manageable, even on his fixed income.
He pays just under $100 a month for prescription drugs. Medicare pays most of his $500-a-month oxygen bill, and the rest is covered by his extra insurance.
The insurance policy takes quite a chunk of his income, but "he can't afford to be without it," said Marcella Rangel, Perez's niece and his legal guardian. "He's usually in the hospital once a year with pneumonia, so he can't afford to drop his medical insurance."
The topic of prescription prices and the elderly has gained a lot of political attention recently. It was a large part of the campaign rhetoric of both George W. Bush and Al Gore during the 2000 presidential election. Kansas lawmakers also have broached the prescription-cost problem.
But how serious is the problem of elderly Kansans and prescription- drug costs, why doesn't Medicare help, why are the drugs so expensive to begin with and are politicians really paying attention?
Meals or medicine?
Ask Perez and his friend Manuel G. Arredondo, 82, or any of the other seniors who gather each day at the Topeka LULAC Senior Center if paying for prescription medicine is a problem. They may not have to forfeit food, but the cost of prescription drugs is an integral part of their lives.
Perez is very hard of hearing, has a portable oxygen tank and takes medicine for his chronic obstructive pulmonary disease and other drugs.
Like many of the seniors, prescription drugs are a big reason he enjoys the quality of life he has. But it is quality that comes at a high price.
Seniors at LULAC will tell you they take not just one or two drugs, but six, seven and eight different medicines, at a cost of hundreds of dollars a month --- medicine that Medicare doesn't pay for, that must come out of a fixed income already strained by high fuel bills and the essentials of everyday life.
Terry McDaniel has worked with one senior who had as many as 23 different prescriptions. She knows of another senior who gets his sole daily meal at LULAC; he can't afford to buy more food, and he is frightened that if he asks for financial help, he will lose the benefits he has.
It is a common reaction, said McDaniel, information and referral specialist with the Jayhawk Area Agency on Aging.
Many of the elderly Kansans she talks to, even when their situations are dire, will tell her that they don't want to take benefits away from someone else who needs them more or that they have never asked for help and aren't about to now. Others tell her they would rather wait, that they may need the help more later on.
"The people I talk to have an average cost of $250 to $300 a month that they're spending (on prescriptions) and (supplemental) insurance that costs $165 to $265 a month," McDaniel said.
Often, the seniors who manage do so because one of their children pays for some of the prescriptions or the supplemental insurance, but not everyone has family members who are willing or able to help, she said.
Many seniors don't want to have to take high blood pressure medicine because they can't afford it, said Jan Hummel, a staff nurse with the Oakland Community Nursing Center, who was checking seniors' blood pressure at LULAC.
Those who are on it sometimes try to save money by not taking their medicine every day, cutting pills in half or not refilling a prescription right away, running the risk of uncontrolled high blood pressure, which could lead to a stroke. If they survive the stroke, there is the real possibility they could be so disabled that their quality of life is greatly diminished.
Mike Conlin, a Topeka pharmacist and owner of Jayhawk Pharmacies, said prescription costs for the elderly start to escalate when there are several chronic conditions.
"Where it starts to accumulate is when they have three or four such as diabetes and hypertension and then they develop ulcers," Conlin said. "When all those things start coming together, it can be pretty insurmountable."
Lipitor, a drug for high cholesterol, for example, can run nearly $2 a day, for one 10-milligram pill a day, Conlin said. Oddly enough, the 20-milligram dose isn't that much more expensive, so sometimes he will suggest the patient get the prescription in the 20-milligram dose and just cut the pills in half.
Pravachol, another high cholesterol drug, costs $75 for a 30- month supply of 20-milligram pills. Vasotec, a high blood pressure medicine, can run $35 for a month's supply at 10 milligrams, the lowest dose, or $28 for the generic version.
Some of the older prescription medicines can be purchased in less- expensive generic versions, but many of the newer ones don't have generic counterparts.
Medicare
Back in 1965, there simply weren't as many prescription medicines.
That is when Medicare, the government's health insurance program, was first established.
When seniors reach age 65, they automatically become eligible for Medicare. Medicare is divided into two parts, Part A and Part B. Part A covers inpatient hospital care, home health, skilled nursing home and hospice care and is financed by a 1.45 percent payroll tax paid by workers and employers.
Medicare Part B pays for 80 percent of physician and other outpatient costs. Part B is a voluntary program and is financed by a combination of beneficiary premiums --- $50 a month that is taken out of a senior's Social Security check --- and general tax revenues.
"When Medicare was first established in 1965, the main concern was the catastrophic cost of a long hospitalization," said Melissa Gregory, director of the Senior Health Insurance Counseling for Kansas program, or SHICK. "Now the trend is to treat on an outpatient basis, so Part B becomes very important."
Medicare will cover the costs of prescription drugs for inpatients and those that can't be self-administered, but it doesn't cover outpatient prescription drugs.
"There's much more emphasis on the preventative side, and there's all these prescription drugs that weren't around then for preventing heart attack and stroke that make a huge difference in the quality of life," Gregory said.
Keeping people out of the hospital and healthy also is a lot more cost-effective in the long run.
The cost of progress
Why are prescription medicines so costly?
It costs an average of $500 million to develop one new medicine, and an average of 12 to 15 years to bring a new medicine from the lab to the pharmacy, according to Pharmaceutical Research and Manufacturers of America.
