By Ret Boney
DURHAM, N.C. — When customers can’t afford to pay for the prescription medications they need, Gurley’s Drug Store in downtown Durham has a monthly pot of $1,000 it uses to help cover the costs.
And with prescription drug costs rising, many low-income people rely on that kind of help.
“There are people all the time who, at the end of the month, run out of money but need to keep taking their medicine,” says Tony Gurley, the lawyer and member of the Wake County Board of Commissioners who owns the drug store.
Some say that need will increase for certain seniors when the new Medicare prescription benefit goes into effect January 1.
Under the federal prescription drug benefit, people who are 65 or over, or who are on Medicare due to disability, regardless of income or assets, will be eligible to for federal coverage.
And while many seniors will have coverage that results in a lower cash outlay overall, some say costs could increase for others, including many of the 130,000 North Carolina seniors who will transition from the state’s plan, which is closing its doors, to Medicare’s plan.
“Some folks are really going to struggle with the cost-sharing requirements of Medicare,” says Gina Upchurch, executive director of Senior PHARMAssist, a Durham nonprofit that works with low-income seniors.
“Many older adults are still going to need help,” she says, “either with premiums, or because they can’t afford to participate in these plans.”
How much individuals pay will depend on what types of drugs they take and which private plan they select to administer their benefits, Upchurch says.
And for low-income people seeking financial assistance, income and assets are an additional determinant of cost.
“It is designed to help low-income people and people with high drug costs the most,” says Bill Wilson, associate state director of AARP of North Carolina, which supported the legislation as “an initial step to provide prescription drugs for seniors.”
On average, the benefit is estimated to result in a 37 percent out-of-pocket cost reduction for participants, says a report by the Kaiser Family Foundation.
But some will pay more out-of-pocket, including low-income people who do not receive federal subsidies and people who fall into the “doughnut hole,” a gap in coverage for people with drug costs from $2,250 a year to $5,100 a year, the report says.
Some also worry the complexity of the plan will be a burden on seniors and the nonprofits that serve them.
In North Carolina, for example, seniors must choose between as many as 58 private insurers to administer their benefit, Upchurch says, not all of which cover all drugs or contract with all pharmacies.
In addition, the most cost-efficient option for a given individual depends on which drugs he takes and, if a particular medication is not covered by the plan, cash paid to buy the drug will not count toward out-of-pocket maximums, increasing costs to the individual.
“The confusion of it will be absolutely overwhelming,” says Upchurch of Senior PHARMAssist, which has shifted money from direct drug assistance to staff who can help seniors navigate the change. “We’re going to need to be there to pick up the pieces.”
She estimates nearly 100,000 Medicare beneficiaries in North Carolina alone will have trouble paying for their medication after the new plan goes into effect.
At the same time, the nonprofits that support those seniors, groups like Senior PHARMAssist, are being stripped of tools they rely on to help, including grants that were coupled with the state prescription drug plan and a decrease in medications donated by pharmaceutical companies.
And that still leaves the uninsured of all ages, about 17 percent of Durham’s population last year, to pay the highest prices at the pharmacy counter.
Until there is a solution for those people, as well as the seniors that could fall through the cracks, help from people like drug-store owner Tony Gurley will be in high demand.
“There a lots of times people don’t have money or government programs,” he says.