Rx Savings for Seniors

Throughout Baltimore, the Peter Lamy Center for Drug Therapy and Aging is signing up seniors for savings on prescription medicines.

By Eric Brosch

It's 8 a.m. and senior citizens begin to arrive at a north Baltimore senior center. They are not there for yoga or tai chi or a game of bridge. They have come from across the city looking for the same thing as seniors around the country-help with the cost of prescription medicine.

As the four-person team from the School of Pharmacy and NeighborCare Professional Pharmacies set up tables, Mary Swem, a program coordinator at the center, hands Shirley Craig, RN, BSN, the medicine list of an elderly woman who couldn't come in that day. Craig looks it over, grimaces, and sighs. "Would you look at that?" she asks no one in particular.

On the bottom of the form, where seniors are asked to list the medicines they take, she has written in 21 prescription and over-the-counter drugs: inhalers, antibiotics, ophthalmic solutions, heart and gout medicines, and over-the-counter vitamins. The woman who filled out the form is in her early 70s and lives in northeast Baltimore on just under $1,200 a month in Social Security and disability compensation. Some of the prescriptions are to be taken only as needed, says Craig, but there is still a substantial upfront cost to buy them and have them on hand.

"Sometimes the cost of their drugs is so high, I don't even want to tally them up," she says.

Craig calls over Assistant Professor Cherokee Layson-Wolf, PharmD, to discuss what they can do for this woman. She has prescription coverage, but it isn't much help. Her plan charges a $10 co-pay for each medication-with a yearly $1,000 limit. Adding up the costs of the woman's medication regimen in her head, Craig estimates that this woman had reached that limit after three or so months, leaving her without coverage for the rest of the year.  Unfortunately, because she has some prescription coverage, the woman is disqualified for the discount prescription drug cards seniors are signing up for at the center.

Although this senior does not qualify for the discount cards, Layson-Wolf is still able to review the woman's medications for contraindications and other problems.

Through the rest of the morning, Layson-Wolf, Craig, and fourth-year pharmacy students Shin W. Kim and Ann Nguyen meet with a dozen or so seniors. They check their blood pressure, review their medications, and sign up those who qualify for the discount drug cards. The program is called Rx Savings for Seniors. It's a partnership between the pharmacy school's Peter Lamy Center for Drug Therapy and Aging and the regional retail pharmacy branch of NeighborCare. The partnership is funded by a $7,000 School of Pharmacy interdepartmental grant. Layson-Wolf is the principal investigator, and Nicole Brandt, PharmD, CGP, director of clinical and educational programs at the Lamy Center, is co-principal investigator. It supports a pilot project to characterize those who seek these types of pharmacy assistance programs and how participants in such programs perceive the benefit of the prescription cards. The grant pays for data collection, materials, and travel expenses for the investigators to visit centers and sign up seniors for prescription discount cards offered by the major pharmaceutical companies.

The project is one of many that fulfill the Lamy Center's mission to improve drug therapy for aging adults through research, education, and clinical initiatives. Pharmacists and students from the center also provide outreach services at senior housing centers through a $76,000 contract with the Baltimore Commission on Aging and Retirement Education. That program includes medicine reviews, "Eating Together" lunchtime educational sessions that cover disease states, and a train-the-trainer program to teach housing center staff to identify medication-related issues. The Lamy Center staff also attends health fairs, where they distribute educational materials and sign up seniors for the discount drug cards.

The cards are meant to offer some financial assistance to low-income seniors, but the cards have their limitations. Each has an annual income cap, as low as $18,000 for individuals, and offers varying discounts and co-pays on only some of a company's brand-name medicines. Often, seniors must sign up for multiple cards because each drug company may offer its own.

"Pharmacists are frustrated and patients are confused. There should be just one card," says Layson-Wolf.

What the discount cards don't offer is a long-term solution. That is one point on which the pharmaceutical companies, politicians, and Layson-Wolf all agree. "This is a stopgap measure," says Layson-Wolf. "It's about providing more access for seniors, especially those who don't have the income to afford prescriptions on a regular basis."

Until the federal government passes a senior drug card plan, Layson-Wolf intends to bring what financial relief she can to as many seniors as possible. "Sometimes these forms are just sitting on the counter at a pharmacy," she adds, "and no one thinks to pick them up."

Communication is important, says Craig. "Most elderly don't seek out help," she says. "They don't think to tell their pharmacist that a medication is too expensive. It's not uncommon for them to avoid taking medicines because of the expense."

Helping them fill out the forms is important, too. "It's easy to accidentally omit a number or a signature," says Layson-Wolf. "Many forms are rejected by the companies because they are incomplete."

For that reason, the Rx Savings for Seniors program has a research component, too. Students involved with the program follow up with seniors to determine if they received their cards in the mail and if they are able to use them.

One senior with good news is Annie. She lists only one medication-for high blood pressure-on the form that Craig reviews. And she meets the income requirement for that pharmaceutical company's card. Just in case her doctor prescribes a new medication, Craig has her apply for every card available.

Craig looks over the form, and Annie asks how much money she'll save with the card. She pays $68 a month now, out of pocket. Craig looks up Annie's medication in a three-ring binder, and tells her the good news: Once she gets her card in the mail, her blood pressure medicine will cost her only a $15 a month co-pay.

It may seem like a small savings, but Annie is grateful for it. Still, pharmacists and seniors are waiting for a permanent solution to the high cost of medicines.