WEST NEWFIELD — Obtaining needed medicines remains a financial challenge for a great many Mainers. I’ll be discussing why prescription drugs are unaffordable, but my primary purpose is to emphasize the extent of the problem and then to describe how some Maine doctors and hospitals are working together to increase access to unaffordable yet often life-preserving medications.
Not only is Maine the only New England state that has not expanded its Medicaid (MaineCare) program for its very poorest residents under provisions of the Affordable Care Act (Obamacare), it’s actually disenrolled thousands of MaineCare beneficiaries, many with chronic diseases that are now untreated. Maine is now the only state in the nation where the percentage of people with health insurance didn’t rise between 2010, when Obamacare was approved, and 2014.
With the cost of prescription drugs doubling over the past seven years, and with the average out-of-pocket cost of many commonly used medications now surpassing $11,000 a year, the elderly or disabled with Medicare coverage or those with ACA marketplace or employer-provided insurance also often struggle to meet increasingly unaffordable policy deductibles, coinsurance and copays.
The more drugs people take and the sicker they are, the more likely they are to experience problems paying for prescription medicines – or to forgo them altogether because of cost. Because of the high price of medications, 43 percent of people in fair or poor health and 35 percent of those taking four or more drugs said they either did not fill a prescription at all, cut pills in half or skipped doses, according to recent Kaiser Family Foundation polling.
MedHelp Maine is listed with both 2-1-1 and the Maine Department of Health and Human Services as a medication access resource, so it often gets referrals from these organizations. In just one 24-hour period, MedHelp Maine heard from:
• A 90-year-old woman discharged from the hospital with an antibiotic prescription that requires a $500 copay.
• An unemployed, uninsured woman with prescriptions for rheumatoid arthritis, ulcers and post-traumatic stress medications. Without these drugs, her conditions remain untreated.
• A 55-year-old man who receives free hospital care – but it does not cover outpatient medications. He can’t afford the insulin for his diabetes.
• A 73-year-old man, now in the Medicare doughnut hole, who finds that the drug he’s been taking for a heart condition will now cost him $800 per month.
Patients such as these, believing there’s nothing that can be done anyway, seldom tell their doctors if they can’t afford their medications. And practitioners, not realizing that patients are having problems obtaining the medications they’ve prescribed, can only assume that their patients are taking them.
MedHelp Maine is a nonprofit organization dedicated to enhancing Mainers’ access to unaffordable prescription drugs. It has provided startup guidance and funding for seven hospital-managed prescription assistance programs throughout the state.
Area physicians who find the medication access process too costly and burdensome for their practices to perform themselves may refer patients to these programs. Skilled personnel, dedicated solely to this task, then identify the most appropriate sources of free or low-cost medications and then manage the application process on behalf of both doctor and patient. In just one recent year, one program alone obtained $5.7 million worth of free medications for over 400 patients of 135 referring prescribers.
Portland-based MaineHealth has centralized its systemwide medication access work through its MedAccess program. With knowledgeable program personnel at six MaineHealth hospitals, MedAccess obtained $24 million in free medications last year.
Because prescription medicines can be obtained only with a prescription, patients must tell their practitioners if they can’t afford needed medications. Clinicians then may choose to prescribe other, less-costly drugs; they and their practice staff may opt to manage the medication access process themselves.
Or, because this work is so complex and time-consuming, they may find it more efficient to refer their patients to their local hospital’s prescription assistance program – a resource that also benefits the facility by limiting preventable and often unreimbursed ER and inpatient services required to treat patients who haven’t been taking their medications as prescribed.
Accessing unaffordable medicines begins with patient-doctor communication. Patients must tell their practitioners if they can’t afford their medications, and prescribers must help them obtain the drugs they need to stay well. Please have these conversations.
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