Drug costs impact the financial well-being of older adults
by Linda Phillips, RN, PhD, FAAN
Published at TheHill.com
February 7, 2019
The Senate Committee on Finance recently invited pharmaceutical executives to testify regarding high drug prices. Many declined the invitation, offering a variety of excuses including one company who claimed their testimony would “create a language-barrier problem.”
Nevertheless, based on this request and recent statements from legislators in the House, is clear that members of both parties are poised to take on the high cost of prescription drugs.
As a gerontologist ( a person who studies the social, cultural, psychological, cognitive, and biological aspects of aging), I say it’s about time.
Drug costs absolutely impact the financial well-being of older adults. Although individuals 65 and older comprise about 15 percent of the U.S. population, they consume around 34 percent of prescription drugs.
AARP estimated that in 2017, the average cost of a brand name drug used to treat common chronic conditions was $6,798 per year. While cumulative rate of general inflation increased 25.1 percent between 2006 and 2017, the prices of brand-name drugs increased 214 percent.
If the older adult pays for Medicare and a Medicare Part D Supplement, some of these costs are covered. However, not every older person is on Medicare and there are still the problems of co-pays and exceeding the yearly limit allowed by Medicare. In 2015 more than 1 million older persons exceeded the limit and the number grows yearly. So the cost of prescription medications is of paramount importance to those with limited incomes.
A factor not being considered in the costs discussion is the use of multiple medications by one individual. On average, older adults living in the community have between nine and thirteen prescriptions filled yearly; the average older person takes about five prescription drugs daily. Based on AARP’s figures, this amounts to more than $30,000 per year. Those in nursing homes take an average of seven drugs per day. So the more drugs prescribed; the more the monetary costs. It is simple mathematics. If we are talking about a couple, multiply the monetary costs by two.
Currently the legislative focus is on limiting the prices charged by “Big Pharma” for individual medications: a simple monetary cost expressed in dollars and cents. However, even the use of a single prescription medication by an older adult can have profound indirect or human costs such as declining health and even death.
As people age, changes in body composition and the way the body processes drugs can result in bad effects, known as “adverse drug reactions.”
The most frequent culprits leading to emergency room visits and hospitalizations are blood thinners, drugs for diabetes and opioids.
In addition, some drugs, known as “potentially inappropriate medications” are particularly costly in human terms. These include some drugs used for pain, anxiety, depression, allergies, and sleep. These drugs contribute to falls and disorientation. Falls are one of the leading causes of preventable death among older adults and disorientation can be misinterpreted as the onset of dementia. Avoiding these human costs requires health-care providers with specialized knowledge about the action of drugs on the aging human body.
To be sure, appropriately prescribed medications can extend life and prevent complications. But, appropriate prescribing for older adults is complicated and reducing the complexity can be tackled by some legislative actions. For example, drug companies should be required to be transparent about how their drug was tested. They need to be required to publish how drugs were tested, the ages of those in the clinical drug trials along with their other conditions and their other drugs, if any.
Limits also need to be placed on direct advertising to consumers. Although drug companies falsely promise a new safe drug for every condition, for older individuals, there is no such thing as a totally safe drug. That fact needs emphasized. Finally, many problems related to use of prescription drugs arise from lack of knowledge among providers. Expanding opportunities for geriatric training of providers who prescribe medications for older adults is absolutely essential.
So, as legislators deliberate about strategies for curbing the high costs of drugs, I urge them to think broadly and devise legislative strategies that assure the best possible effect, with the least number of drugs and the fewest monetary and human costs.
Linda Phillips is the senior director of research and education at the Geriatric Workforce Enhancement Program at the University of Arizona Center on Aging. She is a Public Voices fellow with The OpEd Project.