You probably didn’t know it, but May is officially Older Americans Month. Since many members of the eDrugSearch.com community are seniors, and we are keenly aware of their struggles in managing their prescription drug costs, we thought we would take this opportunity to share some facts about the older population that might surprise you, courtesy of the Department of Health and Human Services Administration on Aging –

• The older population — persons 65 years or older — represents about 12.4 percent of the U.S. population, about one in every eight Americans.
• By 2030, there will be about 71.5 million older persons, more than twice their number in 2000, representing about 20 percent of the U.S. population.
• In 2006 older consumers averaged out-of-pocket health care expenditures of $4,631, an increase of 62 percent since 1996. In contrast, the total population spent considerably less, averaging $2,853 in out-of-pocket costs.
• Older Americans spent 12.7 percent of their total expenditures on health, more than twice the proportion spent by all consumers (5.7 percent).
• Health costs incurred on average by older consumers in 2006 (the latest year for which data is available) consisted of $2,770 (60 percent) for insurance, $859 (18 percent) for drugs, $844 (18.5 percent) for medical services, and $159 (3 percent) for medical supplies.

Unfortunately, our seniors too often bear the brunt of our overpriced healthcare system. While the issue of skyrocketing drug costs for seniors has received less media attention since Medicare Part D was introduced in 2006, the truth is that this costly new entitlement program has helped insurance companies and pharmaceutical companies far more than it has helped individual seniors (as Suddenly Senior explains).

What’s more, many seniors are unaware that they may qualify for additional financial assistance with their prescription drugs and other medical bills.

To commemorate Older Americans Month, we encourage you to tell a senior you love (and that can include yourself!) about BenefitsCheckUp, a service of the National Council on Aging that helps match seniors with benefits programs. BenefitsCheckUp has helped more than 2.2 million people find over $7.2 billion worth of annual benefits.

Take your BenefitsCheckUp here.

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Copays used to be a reminder of how nice it was to have health insurance. Now, too often they are a reminder of how little insurance we really have.

Not long ago, copays for prescription drugs were almost universally small, flat fees — as little as $5, no matter how expensive the medication you required.

The original rationale for the copay was to prevent people from seeking unnecessary care, such as visiting the doctor whenever they had the sniffles. The underlying assumption was that without a small copay, consumers would view medical care as “free” and overuse it.

That may have been the original reason for copays. But it’s not the reason anymore.

Today, those “small” flat fees have grown to as much as $50 or more per 30 day prescription — and that’s not the half of it.

Now, many insurers are demanding that patients pay co-pays based on a percentage of the retail price of expensive medications — as much as 33 percent or more of the total cost.

As NaturalNews.com has reported:

Hundreds of drugs are now being priced this new way. These drugs are used to treat diseases that are fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some kinds of cancer. Unfortunately, there are no generic equivalents for these drugs, so patients are being forced to pay these prices or go without.

People are “going without” because the new copay system means that some patients are required to pay thousands of dollars out of pocket for their prescriptions — even though they have insurance.

It makes you question the very definition of insurance, doesn’t it?

Fortunately, for those who are struggling with co-pay expenses, there is a non-profit organization called the Patient Advocate Foundation (PAF) that can help.

The PAF Co-Pay Relief Program provides direct financial assistance to insured patients, including Medicare Part D beneficiaries, who qualify based on medical and financial criteria. The program offers personal service through phone counselors, who guide patients through the enrollment process.

The program assists insured patients who are being treated for the following conditions: breast, lung, lymphoma, prostate, kidney, colon, pancreatic, and head/neck cancers; malignant brain tumor; sarcoma; diabetes; multiple myeloma; myelodysplastic syndrome (and other pre-leukemia diseases); osteoporosis; pain; hepatitis C; rheumatoid arthritis; selected autoimmune disorders; and CIA/CIN.

If you are struggling to afford your drug copayments, call the PAF Co-Pay Relief Program at 1-866-512-3861 or apply for help online.

We speculated last week that the big health insurance companies and their PBMs (pharmacy benefit managers) may soon attempt to force employees toward mail-order drugs. It’s certainly a real possibility after the PBM Express Scripts began providing mail-order delivery as a default option for employer-based health plans.

As I predicted then:

1. Soon, all other PBMs will offer the same program.
2. Then, one PBM will come up with a program that makes participation in the mail-order program mandatory in order for employees to receive coverage — in the name of employer cost savings.
3. That will become the dominant model for employer-based prescription drug insurance.

I then added, forebodingly:

Now, I haven’t factored in the uproar that this would cause with the Wal-Marts, Rite Aids and the like…

Well, you can forget Rite Aid, because they’re going to go out of business anyway. But Wal-Mart, that’s another story. You could bet they weren’t going to take this sitting down.

So how to fight the PBMs? How about by bypassing the health insurance companies altogether and taking your pitch straight to employers?

As Kaiser posted today:

Wal-Mart on Friday announced that it is in negotiations to expand to several other companies a generic drug purchasing pilot program it currently runs with Caterpillar…

Under the pilot program, Wal-Mart waives the $5 copayment for generic drugs for Caterpillar employees when they purchase their medication at Wal-Mart or Sam’s Club pharmacies. According to the [Chicago] Tribune, the incentive to fill prescriptions at Wal-Mart or Sam’s Club pharmacies boosts Wal-Mart’s pharmacy business and pushes more potential customers into their retail stores, where they might purchase other items.

According to the Tribune, the “most radical aspect of the test … is the threat of unraveling how the health care industry buys and sells prescription drugs.” As part of the program, Caterpillar has a contract to purchase drugs for employees directly from Wal-Mart, bypassing the need for a pharmacy benefits manager…

Walgreens, meanwhile, has announced that it is pursuing a strategy similar to Wal-Mart’s.

This is beautiful, folks. It almost certainly means that the costs of generic drugs will continue to fall in the United States, which is great news. And perhaps the competition between retail pharmacies and PBMs will squeeze some of the inefficiencies out of the current system, reducing administrative costs as well.

Unfortunately, this battle can do little to reduce the prices of brand-name prescriptions, which are the real reason Americans can’t afford to pay their drug bills anymore. Just as drugmakers can dictate their monopoly pricing to the consumer, they can also dictate it to the middlemen.

Still, Wal-Mart vs the PBMs will be fun to watch.

We wrote recently about the rapidly growing business of mail-order pharmacies run by the pharmacy benefit managers (PBM) who work with employer-based insurance providers.

It’s been a trend with no small hint of irony. You see, when Canadian mail-order pharmacies came on the scene in the ’90s, representatives of Big Insurance and Big Pharma trashed the whole idea of the mail-order pharmacy. They said it was unwise — even dangerous — to order drugs without having face-to-face contact with your pharmacist. They said your relationship with your pharmacist was just as important as the one you have with your doctor.

All that would be lost, they said, if you ordered from an online pharmacy. Of course, now that they’ve figured out how to make a buck off of the idea, they love it.

And now, Big Insurance is moving toward a day when you may actually be forced to order your drugs online or through mail-order — whether you like it or not.

As U.S News reports:

Express Scripts, one of the nation’s largest pharmacy benefit managers, has developed a program [called] Select Home Delivery [that] automatically enrolls employees in the home delivery program unless they specifically opt out of it …

That’s right. If your employer’s PBM is Express Scripts, and they sign up for Select Home Delivery, mail-order will be the default option for all employees.

Mark my words here; this is the first of several shoes to drop. Up next:

1. Soon, all other PBMs will offer the same program.
2. Then, one PBM will come up with a program that makes participation in the mail-order program mandatory in order for employees to receive coverage — in the name of employer cost savings.
3. That will become the dominant model for employer-based prescription drug insurance.

Now, I haven’t factored in the uproar that this would cause with the Wal-Marts, Rite Aids and the like. Some kind of accommodation will probably have to be reached to make all the big-money players happy.

And of course, consumers won’t like it, because no one likes having their choices taken away. But how much power do consumers have these days in the face of Big Insurance and Big Pharma, anyway?

When you listen to Express Scripts tout the benefits of Select Home Delivery, you know it’s only the beginning:

“Moving from retail to home delivery may be the most powerful intervention we have today to improve therapy adherence,” says Bob Nease, chief scientist for Express Scripts, referring to patients who follow their prescribed drug regimens. Home delivery also saves patients money, typically up to a third of the prescription cost for a 90-day supply.

So far, about two dozen companies have signed up for the Select Home Delivery program. Home improvement retailer Lowe’s has seen the percentage of prescriptions filled through home delivery rise from about 14 percent to 40 percent since the company signed on, says Nease.

As you know, we at eDrugSearch.com are big fans of mail-order pharmacies. We were fans of mail-order pharmacies long before the insurance companies.

We know that mail-order pharmacies save healthcare consumers money. And we’re glad that millions of consumers will learn through programs like Select Home Delivery that they need not be scared of ordering drugs through the mail.

That will be especially important should these workers lose their jobs or prescription drug coverage — and realize they can pay up to 80 percent less on their medications by ordering through eDrugSearch.com’s network of licensed mail-order pharmacies.

All that being said, we continue to find the arrogance and hypocrisy of the big health insurance companies astounding.

Medco Health Solutions Inc., the nation’s largest pharmacy-benefits manager (PBM), posted a 32 percent rise in fourth-quarter profits today — largely on the growth in the number of prescriptions filled by mail order. Working with employer-based insurance providers, Medco fulfills more mail-order prescriptions than any other company in the United States.

If you have employer-based insurance, it’s likely that your insurance company is now working with a PBM like Medco — and is encouraging you to use them. For the consumer, it can be a good thing — because PBMs have the bargaining power with Big Pharma to bring down your prescription drug prices, and you’re generally not going to see the wide variation in pricing that you do in shopping at your local retail pharmacies.

But as someone who’s observed and participated in the mail-order pharmacy business for some time now, I’ve noticed an irony here.

After Canadian mail-order pharmacies emerged on the scene in the ’90s, representatives of Big Insurance and Big Pharma criticized the whole concept of the online pharmacy.

They said it was dangerous to order drugs without having face-to-face contact with your pharmacist.

They said that a personal relationship with your pharmacist was just as important as with your doctor, and that you should never order drugs by mail.

Now that they’ve co-opted the idea, though, they love it. Absolutely love it.

We’re actually glad people are learning some of the benefits of mail-order pharmacies through their employer-based insurance. Because, God forbid, if they lose their jobs and their COBRA runs out (or they can’t afford their COBRA), they’re going to need another solution.

And saving up to 80 percent off U.S. retail prices through licensed Canadian mail-order pharmacies is, hands down, the best solution out there for the uninsured.

These days, we’d all like to save as much money as possible on just about anything. However, I encounter numerous people every day who spend way too much money on their prescriptions. It’s a common misconception that prescription drug therapy is simply expensive, and there’s nothing you can do about it. With a little effort, though, you can easily cut your drug costs. Here are a few tips for real savings at the pharmacy.

1. Comparison Shop. If you don’t have insurance, comparing the prices at different pharmacies is an absolute MUST. Most people don’t realize just how much pharmacy prices can vary . . . especially for generic drugs. In fact, just the other day, I called around to different pharmacies to check on some prices for a particular generic medication. For just thirty tablets, the price varied from $37.03 to $599.00! And no, that’s not a typo . . . that’s a price difference of 1,617%! While most differences won’t be quite so extreme, the lesson remains the same. You’ve got to comparison shop.

2. Buy in Bulk. Regardless of whether your prescription is for thirty or ninety tablets, it costs your pharmacy the same amount time and money to fill it. Because of this, you often get a price break for purchasing a larger quantity of medication at once. Usually, this is more the case for generic medications than for expensive, brand name drugs.

3. Maximize Your Insurance Benefit. If you have insurance, do you know the maximum amount of medication your plan will cover at once? This is usually determined by the length of time your prescription will last you. For example, some plans will charge you the same copay whether you fill 30 or 90 days’ worth of medication. If this is the case, filling a three month supply of your prescription will cut your drug costs by 67%. Even if your plan will only allow you to fill a month’s worth of medication at a time, you should still determine the maximum days’ supply they will allow. Most doctors habitually write prescriptions for 30 days’ worth at a time. But if your insurance plan will cover 34 days at a time for the same copay, just this small amount will add up—cutting your yearly drug costs by about 12%.

4. Just Say No to Samples. Most prescription savings advice written by people outside the industry recommend asking your doctor for samples of your medication. My stance is the exact opposite of this. In my opinion, if your doctor has samples (or coupons for that matter) for your medication, you need to question whether this drug is really the most cost-effective medication for your condition. Most doctors think they’re doing you a favor when they give you samples. Of course, one or two free months of medication is usually outweighed by paying for an overpriced brand name drug year after year.

5. Split Tablets. Many medications—generics and brand names alike—are priced the same regardless of the strength. Because of this, doubling the strength of your medication and only taking a half tablet can actually cut the cost of your prescription in half. While most people have heard that tablet splitting can save a lot of money, few actually utilize this tactic. And don’t forget, some types of tablets shouldn’t be split. Always ask your pharmacist if this is a safe practice for each particular prescription.

6. Take Advantage of Deeply Discounted Generics. Everyone’s heard of Wal-Mart’s $4 generic program, but many other pharmacies also have deeply discounted generics available as well. If you plan on utilizing such a program, make sure to comparison shop for any non-discounted prescriptions. Many of these pharmacies sell these cheap, generic prescriptions at a loss only to grossly overprice others.

7. Communicate with Your Doctor. Few doctors are experts at prescription pricing. And most of the time, your doctor probably doesn’t know how much your prescriptions cost you. Every week, I speak with a different doctor who is absolutely amazed at how expensive certain medications are . . . and this is only AFTER these doctors have prescribed such drugs! When it comes to your prescriptions, your doctor will be much more cost conscious if he or she actually knows the prices you’re paying for your medications.

8. Follow Your Formulary. A formulary is a list of preferred medications provided to you by your prescription insurance plan. Your doctor usually won’t have any clue as to which medications your insurance prefers. Your copays are usually lower for these preferred medications, so it can make a huge difference if you simply bring your formulary with you to each of your doctor’s appointments.

9. Avoid “New-and-Improved” Versions of Older Drugs. When pharmaceutical companies lose patent protection on their drugs, they usually come out with “new-and-improved” versions of these medications. These new versions are often only slight improvements over the older drugs, but are usually three to five times the price. Whenever your doctor prescribes a new medication for you, ask if it’s one of these “new-and-improved” drugs. If so, request to try the older, more affordable, generic version first.

10. Take Less Medication. This last tip is often the most overlooked. It’s important to regularly review your prescriptions with your doctor, discussing exactly what each of your prescriptions is supposed to be doing and how essential each is. Sometimes, you’ll discover that your most expensive medication is one that you don’t really even need. Of course, you should never stop taking any of your prescriptions without your doctor’s approval.

With the annual election period for the Medicare prescription drug program beginning Nov. 15, elder-care expert Esther Koch says many seniors are currently in the wrong plan and are wasting money as a result. To get in the right plan for 2009, seniors are advised to use the Drug Plan Finder at www.MEDICARE.gov.

Explains Koch:

When it comes to prescription drug coverage seniors fall into 4 groups: seniors with employee or retiree drug coverage; those in Medicare Advantage Plans with drug coverage; those in low income subsidy programs; and seniors who are in stand-alone Medicare Prescription Drug Plans or have no prescription drug coverage. It’s that last group that needs to act…

Koch offers the following three recommendations for this group of seniors:

1. SENIORS MUST REVIEW THEIR DRUG PLANS EVERY YEAR

Why? Because even if their medications haven’t changed it’s almost certain that their plan’s formulary of drugs covered and pricing have. Medicare contracts with a variety of insurance companies to cover drug costs. What few seniors or caregivers know is that these insurance companies submit new plans to Medicare each year … Last year’s plan is not this year’s plan and that means that it’s unlikely that the best plan for you last year is still the best plan for you this year…

2. A HIGHER PREMIUM PLAN DOESN’T MEAN MORE OR BETTER COVERAGE

It seems logical that choosing a drug plan with a higher premium is going to give you more benefits, but when it comes to Medicare Prescription Drug Plans this simply isn’t true. What you need to focus on is total estimated annual cost… This takes into consideration all the variables including the plan’s formulary of drugs; individual drug classifications and pricing; monthly premiums; deductible amount; whether donut hole coverage is provided; and when catastrophic coverage is triggered.

3. WEB-SAVVY BOOMER-AGE KIDS NEED TO BE INVOLVED

If choosing the right plan sounds like it requires sifting through a lot of information, it does. Luckily, the government offers a powerful online tool that makes this process easy to manage. Web-savvy Boomers can help their parents compare stand-alone drug plans by using the Medicare Prescription Drug Care Plan Finder. By entering their parents’ ZIP code, drug names, dosage information, and 30-day supply amounts, Boomers can obtain a prioritized list of drug plan options sorted from the least expensive to the most expensive plan based on total estimated annual cost…

The annual election period for the Medicare drug program runs from Nov. 15 to Dec. 31.

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BusinessWeek published a story this week on “Medicare’s Costly Doughnut Hole,” which mostly rehashes a survey from the Kaiser Family Foundation (reported here previously) that shows many seniors forgo needed medications rather than pay full price for their meds.

The story also reports that the doughnut hole is getting bigger…

The doughnut hole is exacerbating a growing Medicare financial burden on seniors. On Sept. 26, health-care advisory firm Avalere Health released a report predicting Part D beneficiaries will see their premiums rise 24% on average, to $37 a month, in 2009. Those who joined the 10 most popular plans will swallow a 30% increase … Some drug companies offer assistance programs, Fletcher says, but only for the lowest-income seniors, and only for those willing to endure a tough application process. Those who watch Part D carefully worry that some patients may be cutting back on their drug intake altogether to avoid the doughnut hole, even if they’re endangering their health by doing so.

…and that Obama or McCain may have a chance, if not to fill the hole, then to at least reduce its size for some or all Medicare recipients:

Health policy experts believe that the next Administration will be under pressure to address the doughnut hole, and both candidates have expressed some support for reforming the program. Senator Barack Obama (D-Ill.) endorses the idea of letting the government negotiate drug prices for Part D (it doesn’t have the right to do so now). Senator John McCain (R-Ariz.) has said that higher-income beneficiaries should pay higher premiums for their Part D plans.

Both ideas—dropping drug prices and shifting more of the up-front premiums to members who can afford to pay—have been bandied about in Washington as potential ways of at least shrinking the doughnut hole without the government having to pony up more to support Part D. The prospect of a $700 billion bailout of the financial industry is certainly taking attention away from health-care reform, but there is little doubt the next President will place the doughnut hole high on his agenda.

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We talk a lot on this blog about the 65 million Americans without prescription drug insurance, and the millions of additional seniors who fall into the Medicare doughnut hole every year. But for those of you fortunate enough to have an employer-sponsored health insurance plan, we know that life isn’t a bowl of cherries for you, either.

As Sandra Block writes at USA Today:

The average employee’s health care costs, including premiums and out-of-pocket expenses, will increase 8.9% in 2009, according to Hewitt Associates. That’s well above the rate of inflation and average salary increases… For that reason, it’s more important than ever to scrutinize your employer’s health care options during open enrollment season. Don’t assume the plan you used last year is still the best choice…

Specifically, when it comes to prescription drugs, Block advises:

1. If you’re moving to a plan that offers “co-insurance” rather than co-payments for prescription drugs, prepare for your costs to go up.

Many employees are accustomed to making co-payments of $5 to $25 for everything from prescription drugs to doctor’s visits. But increasingly, employers are replacing co-payments with co-insurance in an effort to control costs, particularly for prescription drugs … Under a typical co-insurance model, Abbott says, a plan may cover 90% of the cost for a generic drug, 75% for a brand-name drug that’s on the plan’s preferred list and only 50% of the cost of a non-preferred brand-name drug.

Co-insurance is designed to reduce the cost of prescription drugs by encouraging workers to use generic drugs or the lowest-cost brand-name drugs. Some plans have adopted a hybrid formula that charges a flat co-payment for generic drugs and co-insurance for brand-name drugs … If you’re accustomed to paying $10 or $15 every time you fill a prescription, a switch to co-insurance could raise your out-of-pocket costs … You can save money by using generic drugs whenever possible.

2. Use the provider’s mail-order option for buying drugs.

Most plans offer mail-order delivery of prescription drugs, and these programs can save you a lot of money … Because you’ll receive a larger supply — typically 90 days — you’ll save money on co-payments, she says. You may receive a discount on the price of the drugs, too.

3. Consider contributing to a flexible spending account or health savings account if it’s offered.

Most employers offer flex accounts, which let you use pretax dollars to pay out-of-pocket medical and dental costs. These accounts can help reduce the cost of co-payments, co-insurance and deductibles, but less than a quarter of workers contributed to an FSA in 2008 … You must decide when you enroll in your plan how much you want to contribute during the year.

Of course, the reason most people don’t use flex accounts or health savings accounts is that if you don’t end up using the money you’ve contributed during the plan year, you lose it. So I’d advise you only to use these accounts if there is a predictable level of out-of-pocket expenses that you end up hitting year after year.

Freebies 4 Mom reports on Publix and Meijer offering free antibiotics:

“Free prescription drugs? Did you know that some supermarket/drugstore chains have started offering this free public service recently?

‘Meijer Stores are now offering free prenatal vitamins (similar to free antibiotic programs)! I thought this might be a good freebie to pass along to your readers-I know I’m going to hit it up! Love your website.’ -Allison”

Amy of MomAdvice.com posts on how she got by without prescription drug coverage by trying alternative remedies and using a variety of methods to save money on her prescriptions.”

Great stuff.