Caregivers everywhere are familiar with the high-wire act involved in paying for medications for a loved one in their care. Already working within tight budgets, families find it difficult to absorb recent increases in prescription costs. Carol Thomson, for example, pays $700-800 a month for her mother’s medications, and even though a small grant helped cover the cost over the past year, the grant is about to run out. So far, she has made 30 or 40 phone calls in an attempt to find discounted medications. Fortunately, a few generous physicians have helped her with free samples.
Caregiver Lucille Marinko will be forced to give up the attendant care which affords her a little respite time, because she is unable to pay for both the eight medications she needs for her mother and the additional help.
As we know, Medicare does not cover the cost of prescription medicines. For a while, Medicare supplemental policies—in particular the HMO policies—did cover prescriptions to a greater or lesser extent—sometimes with a cap on how much could be spent each year, sometimes with a given amount for co-pay, and sometimes with options for using generic medications.
However, because prescription costs are the largest cause of the increase in the cost of medical care in the United States—rising at twice the rate of inflation—most insurance companies have put limits on their coverage. Congress continues to debate different prescription coverage programs for Medicare recipients. Meanwhile, caregivers continue to scramble to find money to pay for drugs as well as the myriad other expenses involved in caring for someone with a long-term illness.
Often the people struggling to pay for these medications don’t meet traditional low-income guidelines to qualify for Medi-Cal. When people do qualify for Medi-Cal, the cost of their medications is covered as long as the medications they require are on the formulary (list of approved drugs). When a complicated illness is involved, however, even Medi-Cal eligible patients may need medications not covered by the Medi-Cal formulary. A physician can apply to Medi-Cal for an exemption for his patient; however, the process is time-consuming. Others eligible for Medi-Cal must pay a share of cost approximately equal to their out-of-pocket expenses, leaving a minimal amount each month to live on.
Those not eligible for Medi-Cal face an even more daunting process, as one often must apply to each pharmaceutical company separately, and each company has different criteria to qualify for lower prices.
As the government and insurance companies struggle with this problem, some help is available—although it may take access to a computer and considerable time to find the right program.
Help on the Web
Prescription drug discount programs change quickly, and the available options may be different or even eliminated by the time you read this. If you need help finding the right program for you, call your local Area Agency on Aging or HICAP program or FCA for assistance, (800) 445-8106.