Paul Billings Discusses the Financial Burden of Prescription Drug Costs in Medicare

Unlike commercial plans, Medicare beneficiaries run the risk hitting the donut hole, which causes their costs to go up dramatically, said Paul Billings, senior vice president advocacy for the American Lung Association.

Unlike commercial plans, Medicare beneficiaries run the risk hitting the donut hole, which causes their costs to go up dramatically, said Paul Billings, senior vice president advocacy for the American Lung Association.

Transcript

How does the financial burden of high prescription drug costs among the Medicare population differ from the non-Medicare population?

So, Medicare’s prescription drug benefit is designed differently than many private health plans, and what we see is that patients hit what is known as the donut hole, where their costs go up dramatically through their plan year, and that leads to patients having to face much higher costs when they show up at the pharmacy counter.

We had an experience with a patient that was used to paying $42 for each prescription, and she showed up and it was $175. It was quite a shock to her and she couldn’t afford it. So, patients experience these high costs and all of a sudden it can impact their ability to afford medication, and if they can’t afford their medication, it can lead to a wide range of additional health burdens. People with chronic obstructive pulmonary disease can end up hospitalized when they’ve had an exacerbation, rather than maintaining good health or managing their disease by being able to adhere to their medications.