The Hidden Costs of Health

How Tompkins County's low-income senior citizens cope with the high cost of prescription drugs

Seven dollars and 30 cents. Mary O'Brien had toiled for decades at several Long Island department stores, and now, more than 80 years old and widowed, that's all they could give her. Seven dollars and 30cents a month.


As healthy and vibrant as she was for an octogenarian, she needed a little more than seven dollars and thirty cents to pay for her medication. Her $1,000-a-month Social Security pension certainly helped, as did the $20,000 one department store allotted her for medication when she retired. But that $20,000 was quickly running out, and so were her cholesterol pills, and that $7.30 wasn't going to go far toward the $545 she needed to get a refill at the pharmacy.
           
O'Brien knew she had to do something drastic. She spotted an advertisement in the back of a magazine for a Canadian pharmacy promising to save her money on her prescription drugs -- hundreds of dollars, even. O'Brien knew buying medication from Canada was illegal and worried her medication would be snatched at the border.


But she had no other choice. She dialed the number, and a friendly employee of the pharmacy answered, patiently walking her through the process, reassuring her that everything would be all right. Those $545 cholesterol pills were only $200 in Canada, he said.
O'Brien purchased drugs from the Canadian company for more than three years. This fall, however, O'Brien realized she would no longer be able to afford her medication, even at the Canadian price. She had resorted to getting her drugs illegally, and now she couldn't even manage to pay for that.
           
Fortunately, O'Brien was an active member of Lifelong, an Ithaca-based organization for older adults where she teaches Greek cooking classes every year. Remembering that the organization conducted health insurance counseling sessions every week, she brought her drug information to Lifelong's downtown facility and sat down on a fall afternoon with Harriet London, a Lifelong volunteer trained in the nuances of prescription drug plans. After sifting through her different options, London recommended that O'Brien sign up for EPIC, or the Elderly Pharmaceutical Insurance Program, a New York State prescription drug program for senior citizens having difficulty meeting their drug costs. Under EPIC, O'Brien would pay no more than $20 for those cholesterol pills that were costing her $545 a few years ago.
           
"What a wonderful crew," O'Brien gushed when her meeting with London had ended. "I'm so glad I use their services. I don't know what I would do without them."

Life savers
           
For the low-income seniors of Tompkins County, Lifelong is a trustworthy ally in the perilous world of ever-rising prescription drug costs. Last year, the program guided slightly more than 1,000 seniors through the confusing process of finding the cheapest prescription drug program available. Lifelong provides these services for free, a tremendous benefit considering two-thirds of those who ask for help are living at or near the federal poverty level.
           

"All the people who come here know something can be done, but they don't know what," says Sarah Jane Blake, the retirement services coordinator at Lifelong. "We're here to explain it to them."
           
Low-income seniors who participate in the health insurance counseling sessions have a variety of options. Beginning this year, seniors are eligible to receive Medicare Part D, the new Medicare program that helps seniors pay for prescription drugs.


Part D has been criticized by politicians and the media as being too confusing for seniors. Recipients must choose which of the dozens of plans offered best fits their needs, and are asked to refer to the Internet if they need help. Since members of O'Brien's generation are not often comfortable with using computers, the volunteers at Lifelong can help seniors navigate the system, and find the plan that will save them the most money.
           
"I think it's a positive plan for seniors," says Blake. "It can be confusing, but if they come to us, we can set them up, and they will save money- thousands of dollars sometimes."


EPICis another option for low-income seniors. The program, specific to New York State, is one of the best state senior prescription drug programs in the nation, says London. Annual fees are determined by a sliding scale based on income, never exceeding more than $300, and co-payments are a maximum of $20.
           
"EPIC is really a wonderful program," says London. "Some other states don't even have a prescription drug plan for low-income seniors, so in some ways we're fortunate."

Last resort


Although the federal government considers the purchase of prescription drugs from Canada illegal, a few states--including Minnesota, Wisconsin and New Hampshire-- have promoted the practice, hoping to save some of their citizens money.


While it is illegal, people who buy prescription drugs from Canada for personal use are rarely charged with any crimes, says John Krout, the director of the Ithaca College Gerontology Institute.
 
"The federal government tried to make it illegal, but a lot of times people just ignored it and the states haven't enforced the law," Krout says.


At least four counties in New York- Broome, Westchester, Ulster and Chemung- offer a drug discount card that includes an option to order prescription drugs from a Canadian pharmaceutical company. While it does have a drug discount program for low-income individuals and families known as TompkinsRx, Tompkins County does not have a program in which its citizens can buy prescription drugs from Canada.


Beverly Chin, a member of the Health Planning Council of Tompkins County, says she does not endorse buying prescription drugs from Canada because it is illegal.


"It's something you don't really want to come out and say, 'You should do this,' but the truth is it does save a lot of money," says Chin.

The other side
             
Of course, the great majority of Tompkins County senior citizens do not resort to illegal activities, or even government programs, to help pay for prescription drugs. At Longview, a senior living community located in the town of Ithaca, fewer than 10 of the residents are enrolled in EPIC, according to Ann Rogers, a nurse at the residential community.


Ruth Davis, an 87-year-old Longview resident, received a generous compensation package from the city of Ithaca when she retired from working on the Ithaca Youth Bureau. Without such a package, she says, paying for the eight prescription drugs she takes everyday would prove difficult.
           
"I would be in a terrible position now. You see the prices. I could never do it," says Davis. "It costs me over $2,000 a month to live here, and it goes up every year, like an apartment."
           
The senior citizens at Lifelong and Longview realize the medicines that cause them so many problems also help them to live a longer and healthier life.  Krout says this is an irony not lost on most seniors. 


"Modern medicine works miracles and it extends people's lives," says Krout. "We really do need to be careful not to always make the government or the drug companies the bad guys, because that's not always the case."


For Davis, modern medicine has helped her see her two sons almost become senior citizens themselves. It is an experience that has lead to quite a few shared laughs, she said.


"You know when you feel very close to your children?" says Davis. "We discuss what time of day to take your Lipitor, and what to do for dry mouth. You have a new bonding with your kids after that, let me tell you."

A helping hand
             
Varabhon C., a 76-year-old resident of Ithaca who did not want her last name used, also attended the health insurance clinic on the same day O'Brien did. Like O'Brien, it was her first time attending one of the clinics, but unlike O'Brien, Varabhon was already enrolled in EPIC, and wanted to know whether enrolling in Part D would save her even more money. She had rejected insurance from her employer when she retired 16 years ago, saying the monthly rate was too much for her to pay.  Now, her husband takes 15 medications due to heart problems, and Varabhon is on four or five herself.


One of the volunteers told Varabhon to come back in a month with a list of the medications she and her husband take, so the could look at the Part D plans together to determine whether enrolling made fiscal sense. The volunteer told her she could actually end up paying more for her drugs if she enrolled in Part D.
             
"We'll see if I end up enrolling," she said. 
           
For Varabhon and hundreds of other Tompkins County seniors, paying for the medication that keeps them healthy is a daily struggle. Without the help of Lifelong and government programs like EPIC, they would struggle alone through confusing drug plans and high prescription drug costs.
           
Varabhon laughed. "You have to plan ahead," she says. "[The price of] Medicare is going to go up, and AARP probably will too. Now I have some idea what I need to plan for if I want to save money."