AARP Eye Center
Donna Weiner has had more than her share of health challenges. A breast cancer survivor twice over, she also suffers from a damaged and nearly destroyed pituitary gland.
The good news is that with a synthetic form of human growth hormone, Weiner, 72, of Seminole County, can function “pretty normally,” she says. She is able to work a part-time job as a bookkeeper and also help care for her husband, a disabled Vietnam veteran who’s had six heart attacks, kidney cancer, bladder cancer twice, and prostate cancer. (“Thank you, Agent Orange,” she says dryly.)
The bad news: The drug, Nutropin AQ, can cost as much as $2,700 per month, she says. She came out of retirement to work part-time because she needed the money to pay for her prescription drugs.
Weiner has plenty of company. While about seven in 10 American voters age 50 or older regularly take prescription drugs – it’s 86 percent for those age 65 or older – some 58 percent of older voters say they’re somewhat or very concerned about the cost of prescription drugs, according to a July AARP survey.
Across all political affiliations, whopping majorities of older voters support allowing Medicare to negotiate to bring down the cost of prescription drugs, capping the amount that Medicare beneficiaries pay out of pocket for prescription drugs, and preventing drug companies from charging Americans more than they charge residents of other countries.
The topic draws bipartisan support from elected officials as well. Florida Gov. Ron DeSantis, a Republican, led the state Legislature to approve a plan in 2019 that would allow Floridians to get prescription medications from Canada and other countries, with federal approval. Congress is debating action on lowering prescription drugs this year. And U.S. Sen. Rick Scott has proposed linking prescription-drug prices in the U.S. to costs paid by residents of other countries.
While elected leaders debate the issue, older Floridians face crushing costs.
“I thought I had saved enough. But now every once in a while I need to tap into my principal. Now, I’m looking at the bottom of the barrel,” says Sharon Stone, 86, of Lake Mary. She says she lies awake some nights and wonders how she will shift funds around if the air conditioner goes out or the car breaks down. “It’s sort of a game you play in your head.”
Most of her drugs are generics that are affordable, but because she had two heart attacks and has a family history of heart disease, her doctors also have prescribed two high-priced heart medications she has to take each month. She’s been pushed into the so-called “doughnut hole” that drains money from her wallet.
“I am in a spot where I cannot pay $300 a month for meds,” Stone says. “I know I'm not alone and something needs to be done.”
When older Americans sign up for a Medicare Part D prescription drug plan, the plan covers most of the cost of prescription drugs. Co-pays differ from plan to plan and drug to drug. But once a beneficiary’s total drug costs exceed $4,130 in 2021 (the amount is adjusted annually), the beneficiary enters a coverage gap or “doughnut hole.”
At that point, the beneficiary must pay 25 percent of the cost of their prescriptions. Once an individual has paid $6,550 out of pocket for covered prescription drugs, Part D’s “catastrophic coverage” kicks in and the beneficiary pays a more modest co-pay for generic drugs – often $3 or $4 – and a higher co-pay for brand-name drugs.
After 2020, federal law technically eliminated the “doughnut hole” – beneficiaries pay 25 percent of their drug costs out of pocket, but a combination of discounts from drug manufacturers and payments from their Part D prescription drug plan pays the other 75 percent. But that 25 percent can be a shock, especially for those, like Weiner, who depend on costly brand-name drugs.
Weiner hits the “doughnut hole” every year. Her medical costs regularly exceed the income-tax law standard of more than 7.5 percent of her income in the last two years. “I have to fight with the insurance company every year over the need to get this drug. My doctor has to get involved. It’s a pain.”
She comes from a family that has a high risk of breast cancer, which she attributes to the family’s ethnic European heritage. Too many members of her family for at least three generations have had breast cancer.
The costs involved are more than just the direct out-of-pocket costs. Weiner also maintains “the best insurance I can get,” with Original Medicare A and B and a Medicare supplemental plan with drug coverage offered by United Health Care under the AARP brand. She also has a Delta dental insurance plan. Altogether, her insurance costs run $700 a month.
High prescription drug costs are one of the reasons she’s still working part-time at age 72, while simultaneously battling her own health conditions and helping her husband. She’s a part-time bookkeeper for a group of European investors who own properties in Florida as well as elsewhere in the United States.
Stone, who worked for Charles Schwab, has always worked in finances. A widow, she lives on her Social Security and as prices have gone up on everything from medicine to food, she’s learned to make do. She was thrilled when her doctor told her to cut back on one medication. She cut back the other on her own – without telling him – to save money.
“I tell everyone if you can get a (drug) sample, put it away and save it for when you hit the doughnut hole,” she says. “(Congress) needs to talk to elderly people and find out what they’re experiencing and realize seniors are in very big trouble trying to pay for their medication. They need to talk to their parents.”
Sick of paying high prices for your prescriptions? Here’s how you can get involved and raise your voice.