Friday, March 08, 2002
By Allison Sherry
Denver Post Medical Writer
Hundreds of chronically ill or disabled Coloradans on Medicare are taking drastic measures as they reach new yearly limits set on what they can spend on prescription drugs - and it's only March.
One support group meets twice a month to share medicines. A group of multiple sclerosis patients has begun going to Guatemala for treatment. Some are relocating to the states of Washington or Texas so they can check into across-the-border drugs, which are rumored to be cheaper.
Some have stopped taking the drugs that they need.
"I took my second-to-last shot today," said Ron Wolfe, 38, of Westminster, who has multiple sclerosis. Wolfe said he hopes to move to Washington, where the weather is cooler and he could explore getting a cheaper Canadian version of Avonex.
Wolfe said he has skipped doses to remain under his $1,500 a year limit set by Kaiser Permanente. He is in more pain and more fatigued. "I can't walk across the entire mall," he said.
Thousands of Coloradans on Medicare faced new limits Jan. 1 on the amount of money they can spend on prescription drugs each year.
Medicare is a government health insurance program for people over 65 and for the disabled. Because recipients do not receive any prescription drug benefits, most buy into private plans.
In Colorado, Secure Horizons now caps prescriptions at $1,000 or $1,300, depending on which plan a patient pays for. Kaiser Permanente caps at $1,500 or $3,000 per year, depending on the plan. The Rocky Mountain HMO's cap is about $1,500, depending upon the plan and the region.
Meanwhile, medications for MS, for example, run about $1,100 a month. For many of those patients and others suffering from chronic diseases, when the cap is reached, the medicine dries up.
And for many, that time is this month.
"We had a couple thousand people call the pharmacy. And we worked most of it out," said Steve Krizman, spokesman for Kaiser Permanente.
Kaiser pharmacists have helped find cheaper or generic drugs for the thousands nearing the cap, Krizman said. Doctors also hope to place people into pharmaceutical assistance plans to cover the costs once they run out of money.
Kaiser is no longer enrolling new people in its Medicare program.
Chicki Cabral, 56, of Thornton said she has begun using her MS support group meetings to exchange medication and help people get to Guatemala, where they can get a holistic treatment instead of the traditional drugs that they can't afford anymore.
"Someone will need some help and we'll stand up at a meeting and say, "Does anyone have any Betaseron?' " Cabral said. "Someone might, and we will help them out."
Forty-seven-year-old Tom George has had MS for 19 years. He goes to Guatemala for herbal treatment, and will continue to fork out his own money for that because he knows he can't get the extensive MS drugs or treatment here with Kaiser.
"I am an (accountant) by trade and I look at these things and I can't avoid doing a little analysis," he said. "In my case the drugs were running $1,000 a month. . . . There is no way they could keep on paying that."
But what irks Hal Prink, a board member for the nonprofit Patient-Advocacy Coalition, is that HMOs charge patients the drugs' retail value, not what the drug actually costs the health plan.
"I actually have no problem with HMOs doing that, I just wish they would tell their patients they were doing that," he said.
If these patients were on a regular private health plan, they could probably get unlimited prescription drug coverage, Prink said.
"My feeling was that I wanted to be eligible for Medicare, and when I became eligible, it became a curse," Wolfe said. "If I wasn't on Medicare I could go over to Kaiser, enroll in an individual plan and have no cap on my insurance."
Amy Hudson, a spokeswoman for Secure Horizons, Pacificare's Medicare health plan, said Wolfe and others feel punished because Medicare doesn't give as much money to private health plans as employers do to cover their workers.
"We've had to make some tough decisions," Hudson said.
The problem is not confined to Colorado.
Nationwide, 10 million Medicare recipients say they have no one to pay for their drugs. An additional 7 million say they have run up against price caps already this year, said Bob Pierce, a program administrator for the Colorado Division of Insurance.
Pierce said he tries to get the word out about alternatives, but that can be hard when people don't have Internet access, he said.
Drug companies offer reduced-cost drugs for people with certain income levels. AIDS patients can get cheaper AIDS cocktails under the Ryan White program. Some hospitals enroll people for low-cost programs for prescription drugs.
Medicare caps in Colorado
Limits imposed by HMO providers Jan. 1 on prescription-drug spending for Medicare patients in Colorado:
Secure Horizons: $1,000 or $1,300, depending on plan.
Kaiser Permanente: $1,500 or $3,000 per year, depending on plan.
Rocky Mountain HMO: About $1,500, depending on plan and region.
What it means
Many more drugs are more expensive than that, just for a month's worth.
For multiple sclerosis patients, for example, rounds of Betaseron run $1,194.28 a month. The drug helps patients battle pain and fatigue. A month's worth of Avonex runs about $985, and Copaxone runs $1,070 a month.
Sources: Secure Horizons, Kaiser
Permanente, state Division of Insurance
Copyright 2002 The Denver Post