Don't Increase Drug Co-payments for the Most Vulnerable
By Millicent Gorham
In our nation, African Americans die about 5 years earlier than their white counterparts.
Unfortunately, this gap could soon widen. Federal officials are considering changes to a Medicare program that would make it tougher for low-income African-American patients to afford their medicines. Without those drugs, they may get sicker and incur higher healthcare costs.
Specifically, officials are targeting the Medicare Part D Extra Help program, which helps low-income seniors and people living with disabilities pay for prescription drugs. To qualify for the program, beneficiaries must make less than $17,820 per year and have few assets. Extra Help guarantees that enrollees will not have to pay more than $2.95 for generic medicines or $7.40 for brand-name ones.
To cut Medicare costs, officials want to force Extra Help beneficiaries to switch from brand-name drugs to cheaper generic ones. So they have proposed doubling the co-payments on brand-name drugs and lowering them for generic ones.
African-American patients would feel the sting of these changes the most. Seventy percent of African-American Medicare Part D beneficiaries are enrolled in Extra Help, compared to 54 percent of Hispanic beneficiaries and 40 percent of all beneficiaries.
Disrupting African-Americans' doctor-approved treatment plans is particularly cruel, since African-Americans suffer higher rates of chronic diseases. They are 40 percent more likely than whites to have high blood pressure. The rate of diabetes among African-Americans is 77 percent higher than among whites.
If co-pays for brand-name drugs double, many patients will find them unaffordable.
Patients would respond to the higher costs in one of two ways -- and both are disastrous.
Many patients might stop taking their medicines or take them less frequently, to make the supply last longer. Studies show that small co-pay increases in Medicaid reduced cancer patients' adherence to their prescription regimens. They predictably got sicker, requiring more emergency room visits that resulted in higher healthcare costs.
Or patients might switch to generic prescriptions, as officials hope. Generics are usually a great option for patients.
But sometimes, patients experience negative side effects when they switch from a brand-name drug to a generic. That is because even though generics have the same active ingredients as brand-name drugs, they can have different inactive ingredients that affect how patients' bodies react.
For example, patients who substituted the brand name version of an antidepressant for the generic version experienced "intense side-effects not seen when using the brand name drug." They felt jittery and nauseous and no longer "clear." That is because the generic version released the active ingredients faster than the brand-name drug.
Such negative reactions, which are harmful in and of themselves, spell double trouble if they cause patients to stop taking their medicines entirely. A study of nearly 500,000 Medicare Part D beneficiaries with diabetes found that those who did not adhere to their medicines had higher rates of hospitalization, ER visits, and death compared to those who adhered.
Increased visits to the hospital raise healthcare costs for patients and the healthcare system as a whole.
Health care providers do not prescribe brand-name prescriptions on a whim. They have good reasons for choosing those versions over generics.
Disregarding the health care providers' expert opinions and depriving low-income seniors of these drugs will harm their health and likely increase costs. Access to the appropriate medicines is a life or death matter, especially for low-income, African-American Americans.
Millicent Gorham is executive director of the National Black Nurses Association.
