Most Medicare beneficiaries take prescription drugs regularly; many need more than one prescription drug to manage their health. Even with a variety of prescription drug coverage options for people with Medicare, about 14 percent of beneficiaries age 65 and older have said they skip or do not fill their prescriptions because of the cost.
The Inflation Reduction Act (IRA) — passed in late 2022 — included multiple provisions aimed at making drugs more affordable and accessible for Medicare beneficiaries, including a $2,000 yearly limit on beneficiaries’ out-of-pocket expenses for Part D prescription drugs. However, there is more policymakers need to understand about beneficiaries, providers, and drug costs.
To gain this insight, we partnered with public opinion research firm PerryUndem and convened 10 focus groups: eight consisted of Medicare beneficiaries and two were composed of providers from a variety of specialties. The participants were diverse with respect to age, gender, race, ethnicity, and location.
Costs Are Main Concern for Beneficiaries
Cost was top of mind for all beneficiaries despite most being able to obtain their prescription drugs. One beneficiary described how cost kept them from filling a prescription: “I’m not taking that medication because I can’t afford it . . . my kidney doctor is not as happy with me as he could be because I’m not taking the medication he wants me to be on. But I have no alternative.” Another beneficiary described paying for drugs even when they couldn’t afford them, “My medicine costs $840 . . . I buy it because I don’t want to be sick.”
Several beneficiaries said that small changes in costs could be problematic. One beneficiary said that even a $20 increase would cause concern, especially for a medication they needed on a consistent basis. Another beneficiary emphasized needing to avoid being surprised by changing costs. “I’ll go back to the drugs to see the things I’m taking . . . has anything changed? If I’m going to have a $200–$300 [increase] per month for a prescription, it’s really going to affect my budget, so it’s very important to me.”
Avoiding or Reducing Drug Costs
Beneficiaries described taking drug costs into account when they choose their Medicare plan or make decisions to purchase medications outside their Medicare coverage. One beneficiary said: “One of the first things I do when it’s time to re-up a Medicare plan is look at the formulary and make sure the plan is still gonna cover most of my medications.” This person went on to say that they’d look for other plan options if drug coverage was inadequate. However, some beneficiaries said they were looking beyond their Medicare coverage to afford prescriptions — either to purchase drugs not covered by Medicare or to find more affordable prices. Some beneficiaries described using online discount drug sites, such as Good Rx or Mark Cuban Cost Plus Drugs, to explore lowering the cost of their medications. “I used Good Rx once and found out that I saved considerably,” one beneficiary said.
We heard about skipping doses and “stretching” prescriptions from a few beneficiaries, which could have negative health consequences. One beneficiary said: “To stretch it, instead of taking it once or twice a day, depending on what I eat or how I feel, I take maybe one at lunchtime and then go to the next day, and then kind of play with it.”
Providers Recognize Cost Issues
In addition to attempting to curb costs on their own, beneficiaries also look to their providers for options. One beneficiary said, “We’ll discuss the different medications that are out there that will do some of the same things. And then we’ll compare the cost . . . and then [my doctor] will go with what I feel will work for me and the cost of it.” Patients reported a high level of trust in their doctors, especially those with whom they’ve had long-term relationships. As one patient described, “I’ve been going to the same doctor for 30 years now . . . and we’ll discuss the different medications that are out there that will do some of the same things. And then we’ll compare the cost. Can I do an over-the-counter? Do I need a prescription? Do they offer a generic?”
Provider participants in the focus groups said they see the cost of prescription drugs as a big issue for their patients and that cost is the biggest factor driving compliance. One provider said, “You know if they can’t afford it, they won’t take it, and they may not tell you unless you ask them.” However, providers didn’t agree on their role or that they have an obligation to help their patients navigate their prescription drug costs. While some saw it as an essential part of patient care and integrated cost considerations into prescribing decisions, others felt that it was too big of an issue for them to do appropriately and they didn’t have the knowledge, time, or resources to manage effectively.
Conclusion
Patients in Medicare face cost concerns accessing their prescription drugs and frequently engage in strategies to improve affordability, including having discussions with their providers. Assurance that prices are predictable month to month could be helpful to Medicare beneficiaries, as would affordable, standardized pricing. Addressing these issues are likely to help improve adherence to needed medications.
A full report of the focus group findings is forthcoming.
