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IMPORTANCE OF PRESCRIPTION DRUGS TO MEDICARE BENEFICIARIES
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Part of modern medicine. Prescription drugs serve as complements to medical procedures (e.g.,
anti-coagulents with heart valve replacement surgery); substitutes for surgery and other medical procedures (e.g.,
lipid lowering drugs that lessen need for bypass surgery) and new treatments where there previously were none
(e.g, drugs for HIV and Parkinson’s). Some of the major advances in public health -- the near eradication of polio
and measles and the decline in infectious diseases -- are largely the result of vaccines and antibiotics. And, as
the understanding of genetics increases, the possibility for pharmaceutical and biotechnology interventions will
multiply.
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Greatest need for prescription drugs. The elderly and people with disabilities are particularly reliant on
prescription drugs. Not only do they experience greater health problems, but these problems tend to include
conditions that respond to drug therapy. As a result, about 85 percent of beneficiaries fill at least one
prescription a year. Some examples of common conditions include:
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Osteoporosis: Over 1 in 5 older women have osteoporosis and about 15 percent have suffered a fracture as a
result.1 It is a leading risk factor for hip fractures, which affects 225,000
people over the age of 50. Estrogen replacement can reduce the risk of osteoporosis as well as that of
cardiovascular disease. One commonly used drug costs $20 per month, $240 per year.
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Hypertension: About 60 percent of people over age 65 have
hypertension.2 African Americans are more likely to have hypertension. For a
person over age 55, hypertension increases the risk of a heart attack or other heart problem over 10 years by
10 percent.3 Hypertension roughly doubles the risk of cardiovascular disease
and is the leading factor for stroke. According to one study, treatment results in a one-third reduction in the
probability of stroke and a one-quarter reduction in the probability of a heart
attack.4 ACE inhibitors which typically cost $40 per month, $480 per year
are commonly prescribed to control hypertension, and are frequently used in combination with diuretics and/or
beta-blockers.
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Myocardial Infarction (Heart Attack): Heart disease is the leading cause of death for persons 65 and over.
About 1.5 million Americans each year have heart attacks, which are fatal in about 30 percent of patients. Since
people who survive heart attacks are much more likely to have subsequent attacks, disease management including
drugs can significantly improve health and longevity. For example, a study of the use of a lipid lowering drug by
people who had an acuate myocardial infarction found a 42 percent reduction in coronary mortality after 5 years of
follow-up.5 A common lipid reduction drug costs about $85 per month,
$1,020 per year. A beta-blocker costs about $30 per month, $360 per year, and can reduce long-term mortality
by 25 percent.6
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Adult-Onset Diabetes: About 1 in 10 elderly have Type I or II diabetes.7
Diabetes can lead to blindness, kidney disease and nerve damage. Glucose (blood sugar) control can prevent or
delay these conditions. Commonly used medications include cost around $60 per month, $720 per year.
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Depression: An estimated 1 in 10 to 1 in 20 community-based elderly experience
depression.8 Depression can lead to institutionalization and other health
problems. From 60 to 75 percent of patients respond to drug therapy.9 New
therapies can cost from $130 to $290 per month or $1,560 to $3,480 per year.
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Many beneficiaries need drugs but do not use them as prescribed because they do not have well managed, affordable
drug insurance. Most research has found that drug coverage influences use of needed drugs:
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Decreased use of needed medications. Elderly and disabled Medicaid beneficiaries experienced significant
declines in the use of essential medicines (e.g., insulin, lithium, cardiovascular agents, bronchodialators) when
their Medicaid drug coverage was limited.10 Many elderly must choose
between prescriptions and other basic household needs.11
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Increased nursing home use. Medicare beneficiaries whose Medicaid drug coverage was limited were twice as
likely to enter nursing homes.12
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Less protection against drug complications. Even though the elderly and disabled take more prescription
drugs and have more complex medical problems, Medicare beneficiaries without coverage do not benefit from drug
management. This could lead to adverse drug reactions, inappropriate use of drugs, or discontinuation of needed
drugs. One study which classified the geriatric admissions to a community hospital found that drug-related
hospitalization accounted for 6.4 percent of all admissions among the over 65 population. The study estimated
that 76 percent of these admissions were avoidable.13
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