Tag Archives for RIPAE

Lawmakers Consider Proposals to Reduce Costs of Prescription Drugs

Published in the Pawtucket Times on April 15, 2002

Amid the political bickering over the separation of powers bill and the controversy over allowing Rhode Islanders to vote next November on bringing gambling to the Ocean State, the Rhode Island General Assembly is getting around to considering three legislative proposals with broad public and bipartisan political support.

In the shadow of a huge state budget deficit, bills strongly endorsed by both senior and disabled advocates, would make pharmaceutical costs affordable while not costing the state one penny.

It was standing room only last Wednesday in Room 35 at a House Finance Committee hearing, chaired by Chairman Steven Costantino (D-Providence), of the subcommittee on human services. The legislative hearing, lasting almost four hours, drew the attention of the Rhode Island Commission on Aging, the Forum on Aging, the Gray Panthers, and Choices, to name a few.

Dozens of aging and disability advocacy groups, staffers of the Department of Elderly Affairs and the Department of Human Services, and lobbyists for the powerful pharmaceutical industry came to listen to testimony that would officially kick of the state’s debate on lowering pharmaceutical costs for seniors and persons with disabilities.

Under on legislative proposals (H 7291/S 2729), the state Department of Human Services would seek a waiver from the federal government allowing Rhode Island to use Medicaid funding to pay for prescription drugs for low-income seniors with incomes of up to $ 17,720 and couples with incomes up to  $ 23,880.

This bill, authored by Lt. Gov. Charles Fogarty and sponsored by Rep. Constantino and House Finance Chairman Gordon Fox, would enroll approximately 90 percent of the 37,500 seniors now enrolled in the Pharmaceutical Assistance for the Elderly Program (RIPAE) – the state’s pharmaceutical program. Because these seniors would now quality for prescription drug coverage under Medicaid, all Food and Drug Administration (FDA) drugs would be covered, not just those currently covered under RIPAE. Seniors would likely pay small co-payments, probably less than $ 10, rather than the 40 percent co-payments currently charged.

At this hearing, testimony was gathered on two other Fogarty legislative proposals that would make prescription drugs  more affordable to seniors and persons with disabilities who are not covered by the waiver. One bill (H 7290) would allow seniors enrolled in the RIPAE – approximately 5,000 seniors – to buy prescription drugs not currently covered by RIPAE at the discounted state price.

The second (H 7524) would allow 4,300 low-income persons on Social Security Disability Income (SSDI) who are between ages 55 and 65 to become members of RIPAE and purchase prescription medications at the state discounted rate.

Under both of these legislative proposals, the state would be able to obtain the manufacturer’s rebate available through RIPAE. Rebate funds gained from drug purchases by persons in the new SSDI part of RIPAE would accrue in a special fund to be used to subsidized the cost of these drugs in the future. This legislative initiative, like the other two, would be of no cost to the state.

There’s a very good reason why these proposals should be enacted, says Fogarty, who chairs the state’s Long-Term Care Coordinating Council. “Far too many of our seniors still face great burdens in paying for their medications. If your income is less than $ 10,000 per year – which is the median income for a person on RIPAE – having to pay $ 1,000 or more out of pocket for one’s prescription is a big problem.

“This year, in spite of our budget woes, we have a tremendous opportunity to greatly expand our prescription assistance program for seniors and persons with disabilities. By taking advantage of federal Medicaid dollars, we can save seniors millions and we can do these expansions with no added costs to the state,” Fogarty adds.

Susan Sweet, who represents CHOICES, a home and community advocacy agency and the Rhode Island Minority Elderly Task Force, says the expansion of RIPAE is critical, especially in light of the federal government’s failure to create a federal Medicare pharmaceutical benefit.

“Being able to pay for prescriptions avoids sickness, unnecessary hospitalizations and admissions to nursing homes, saving millions of dollars and many years of productive lives for seniors,” says Sweet. “Pharmaceutical products are the current and future medical miracles, and health insurance is inadequate without adequate drug cover, she says.

Shirley Kaiser, president of the Rhode Island Gray Panthers, whose group has battled years for putting the brakes on rising pharmaceutical costs, says seniors are giddy with the news that Rhode Island may finally move to addressing the problem.

The Gray Panthers strongly endorse the legislative proposals, and she believes this is the year for enactment of a legislative remedy.

At the Rhode Island General Assembly, some bills are enacted while many die during the legislative process, even those with great merit.

In light of the state’s fiscal uncertainties, lawmakers now have a rare opportunity to assist older Rhode Islanders and persons with disabilities in obtaining affordable prescription drugs at no cost to the state coffers.

With the widespread support and endorsement of these legislative proposals from state officials, aging and disability advocacy groups, and the pharmaceutical industry, for me it’s a no brainer – pass these bills and quickly sign them into law, says Kaiser.

It is now time to put this longtime aging issue behind us and move forward to other pressing matters like creating and paying for a seamless long-term care system.

Ensure passage of the three bills by telling your representatives and senators how important these three proposals are for you, and request their passage.

Seniors Held Their Ground During Legislative Session

Published in Pawtucket Times on July 16, 2001

As the dust settles with the aftermath of the 2001 General Assembly session, senior advocates and providers held their ground with the state legislature allocating small funding increases in some existing programs, but no major expansions or new programs were implemented.

More than 2,500 bills were introduced during the 2001 General Assembly session, with lawmakers considering a small handful of proposals that specifically targeted senior programs and services.

Pawtucket Rep. Antonio J. Pires, who heads the House Finance Committee, gives his take to The Times on the session as it related to older Rhode Islanders.

During this year’s legislative session senior advocates called on the General Assembly to consider increased funding for Rhode Island Pharmaceutical Assistance to the Elderly Program (RIPAE).

Recognizing the high cost of prescription drugs and its adverse impact on the elderly, lawmakers ratcheted up the $10.3 million RIPAE program by $ 2 million. With the passage of the state’s Fiscal Year 2002 budget, the size of a large phone book, lawmakers appropriated a 20 percent increase to support the RIPAE program, stated Pires.

The General Assembly expanded the drug formulary lists of drugs to include prescription drugs to treat osteoporosis,” Rep. Pires noted. Additionally, he added that the state’s budget now provides 100 percent of covered drug costs incurred once the program’s poorest clients spend more than $ 1,500 in coo-payments in a year.

While senior advocates had pushed for more drugs to be covered by RIPAE drug formulary, Pires stated, “We can’t afford to pay for an o pen formulary program yet because of budgetary limitations.” In next year’s legislative session, when more state monies are available, coverage for gastrointestinal drugs will seriously be considered, he added.

“It’s a trade-off,” Pires said, in explaining why lawmakers choose not to add drugs to the RIPAE formulary list but rather to increase the eligibility income limits to allow an estimated 3,l50 seniors and disabled persons to participate in the state’s Medical Assistance Program. This program pays for nursing home care for low-income eligible seniors. The enacted state budget included $ 1.8 million from all sources of funds, including $ 857,485 in general revenues to increase the eligibility income for those who are 65 years old or disabled. Now individual income limits increased from $ 576 to $  686 per month, he said, noting that income limits for couples also increased from $ 889 to $ 921 per month.

According to Pires, the Fiscal 2002 State budget also includes $ 85,000 to continue funding the state’s elder guardianship program enacted last year. “The program brings volunteer guardians to assist frail elderly who are cognitively impaired and without families or friends in decision making,” he said. This year’s funding would allow a full-tie coordinator to be hired who will recruit and train the volunteer guardians. Ultimately, the funding would also allow the program to be phased in statewide over a three-year period, he said.

“We also continue to fund the state’s Elder Information Network Program,” Pires added, noting that the FY 2002 budget includes $ 425,000, a $ 12,300 increase over last year’s budget. Funding for this program provides grants to 15 community-based agencies to employe specialists to link information and services across the state.

This session Rhode Island lawmakers also moved to soften the blow of federal cutbacks to RIPTA by providing an additional $ 2.5 million to the state’s transportation agency. “RIPTA found itself in need of cutting routes to balance it’s budget,” Pires stated, noting that the General Assembly responded to the federal cuts by appropriating one-half cent of the state’s gasoline tax to help the agency keep its exiting bus routes.

“RIPTA may have to make some adjustments to their bus routs but not to the extent that they had fared,” Pires said. Ensuring that buses continue to run throughout the state are important because this mode of transportation provides older riders their mobility and independence, he said.

Finally, on the heel of calls by the nursing home industry and senior advocates, Pires noted that the General Assembly allocated $ 4.5 million with a $ 4.5 million federal match, to provide higher salaries for certified nursing assistants to keep them in their profession.

While nursing home providers did not get the $ 14.1 million, they requested, the 2002 state budget called for a funded study to develop a new plan on how nursing homes would be funded, Pires said. “We anticipate that the modern payment principles that will be developed will ensure continued quality of care for the elders in facilities,” he added.

But the funding allocated by the General Assembly to alleviate the direct care staff shortage and a study to develop a new payment methodology still leaves many nursing home providers and senior advocates seriously concerned about the direction of quality care with the inadequate paid to a shrinking work force.

Based on an independent study, providers found that last year health care worker turnover approached 92 percent in Rhode Island facilities due to low wages in relation to the work performed, stated Hugh Hall, chair of the  Direct Care Staffing Coalition and administrator of Cherry Hill Manor.

Hall noted that certified nursing assistants must complete 125 hours of training followed by a state licensing exam, both written and practical, to perform this type of work. These workers have found they can make as much or more working in local retail establishments than in nursing facilities, he says.

While nursing home providers appreciate the funding that the legislature has approved, it doesn’t go far enough, says Hugh, to address the inadequate wages that the state is funding for direct care workers. “The state continues to cut the same size of the pie for an ever-increasing aging population,” he noted.

In response to those seeking better funded programs this year, Pires stated, “We had limited resources to expend so there wasn’t a lot of new programming this year but quality of life and independence remains my top priority as chairman of the House Finance Committee.” The eight-term Democrat noted that this year’s focus was to ensure that the existing level of senior services would not be cut but maintained with some incremental expansion.

Many Seniors Struggle with High Cost of Medications

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.