Published in the Pawtucket Times on June 18, 2001

Many seniors are struggling to pay the spiraling cost of prescription drugs as a politically divided Congress seeks a solution by crafting a bipartisan prescription drug benefit tied to Medicare.

Until this issue is addressed, a tragedy occurs in many communities across the nation.

Often, the high cost of prescription drugs has forced seniors on fixed incomes into not taking their medications at all or using only partial doses.

Noncompliance in taking medication can lead to hospitalization, nursing home admission or premature death.

According to the Families USA study released in June 2001, costly prescriptions continue to hit seniors hard in their pocketbook.

The report found that 50 of the most heavily prescribed drugs for seniors on average rose more than twice the rate of inflation in the year ending January 2001.

On average, the researchers found that prices increased by 6.1 percent from January 2000 to January 2001, though the rate of inflation excluding energy in that time period was 2.7 percent.

Furthermore, the 18-page report stated that seniors are most affected by any prescription drug price  increase.

Although older persons represent just 13 percent of the total nation’s population, they account for 34 percent of all prescribed medications dispensed and 42 percent of all prescription drug spending.

Of the 50 drugs used more frequently by seniors, the average annual cost per prescription as of January 2001 was $ 956, the report noted.

Drug prices rose significantly over the one-year period of the study.

The report findings revealed that the cost of Synthroid, a synthetic thyroid agent, rose by 22.6 percent; 22.5 percent for Alphagan, commonly used to treat glaucoma; 15.5 percent for Glucophage, prescribed for treating diabetes; and 12.8 percent for Premarin, used estrogen replacement.

While rising drug costs are national, Rhode Island fiscal nets are in place to make prescription drugs more affordable to low-to-moderate income seniors, says Susan Sweet, consultant and advocate for a variety of nonprofit agencies and minority groups.

Many aging advocates and state legislators know Sweet as “the mother of the Rhode Island Pharmaceutical Assistance to the Elderly Program (RIPAE).”

“Rhode Island is one of a handful of states that has responded to senior’s concerns and anxieties about the high cost of prescription drugs,” Sweet says.

In 1985, the Rhode Island General Assembly moved to assist elders with rising prescription drug costs by enacting RIPAE.

Initially, the RIPAE program covered only medications purchased by low-income seniors to treat hypertension, cardiac conditions and diabetes.

In the past fifteen years, the General Assembly has expanded the program,” Sweet adds, to over the cost of prescription drugs to treat glaucoma, Parkinson’s disease, high cholesterol, cancer, circulatory insufficiency, asthma, chronic respiratory conditions, Alzheimer’s disease, depression, incontinence, infections, arthritic conditions and prescription vitamins and mineral supplements for renal patients.

Additionally, the RIPAE Plus Program, proposed by Lt. Governor  Charles Fogarty with House and Senate leadership, allowed moderate income seniors to purchase prescription drugs at a lower rate that is negotiated by the state.

The state also pays a portion of the remaining cost of the drug based on the senior’s income level.

“The innovations in RIPAE have made Rhode Island a leader in assisting seniors to stay healthy and independently,” Sweet says.

With the end approaching to this year’s session of the General Assembly, lawmakers are considering legislation to again expand the RIPAE Program, states Fogarty, who authored the legislation.

Fogarty’s RIPAE Next Step would cover all FDA-approved prescribed drugs, excluding cosmetic and experimental drugs, cap out-of-pocket expenses at $ 1,500 annually, and open up the program to people age 55 and over who are receiving Social Security Disability Insurance.

While no one really opposes the passage of RIPAE expansion this year, ultimate passage of the entire legislative proposal is really a question of competing budget needs and limited state dollars, Sweet comments.

House Finance Chair Tony Pires (D-Pawtucket) remembers a time in the mid-1990s when Governors Bruce Sundlun and Linc Almond attempted to roll back the RIPAE program by calling for an increase in the senior’s co-pay and limiting access to benefits.

“The General Assembly made it very clear that it did not want to reduce state support, but rather moved to increase benefits,” Rep. Pires said.

“This year we’ll be expanding the list of drugs to include prescription drugs used to treat osteoporosis,” Rep Pires tells The Times, adding that House leadership also supports an out-of-pocket prescription drug cap of $ 1,500 annually.

With the RIPAE Next Step’s price tag of $ 3.5 million dollars. “We can’t afford to pay for an open formulary program yet because of budgetary limitations,” Rep. Pires states.

In upcoming legislative sessions, coverage for gastrointestinal drugs will seriously be considered, he adds.

“In the upcoming years the state’s pharmaceutical assistance program will remain a top priority to the General Assembly, Rep. Pires says. “There will be an expansion of coverage to a full formulary when more state monies become available, he adds.

Currently, Lt. Governor Fogarty estimates that more than 170,000 Medicare beneficiaries in Rhode Island, who do not meet the state’s pharmaceutical assistance program’s income eligibility requirements, lack comprehensive prescription drug coverage.

With an aging population, Congress and state lawmakers must roll up their sleeves to find innovative ways of making prescription drugs affordable.