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Drug Costs Forcing Seniors To Choose

Some HMOs are not paying for name brand drugs anymore

With many health maintenance organizations no longer paying for name-brand prescription drugs under Medicare plans, some seniors are being left with bills fSenior Drug Costsor thousands of dollars, and being forced to choose to between buying life-saving medicine or other necessities like food.

For Gloria Donaldson, her rheumatoid arthritis and asthma and her husband Fred's heart and skin ailments, their doctors prescribe pills they take by the handful every day.

But medical problems are no longer their biggest worry.  "My Social Security pays me $1,350 a month. Every dime of it, every single dime of that money will go this year to paying for name-brand drugs," Fred Donaldson said.

Starting this past January, HealthNet and many other HMOs stopped paying for name-brand prescription drugs, and many of the drugs the Mastersons use are not offered in generic form.

Last year they spent $6,000 on drugs. This year it will cost them more than $30,000 to get all the medication they need.

"If I live to age 77, we're not going to be able to stay here, no way, we'll have to sell this house, downsize to an apartment someplace, probably one of the cars will have to go. There will be a lot of things that we'll have to do in order to survive," Donaldson said.

Federal lawmakers are aware of the excruciating choices facing people like the Donaldsons, but so far, they haven't been able to agree on a plan to help.

The Donaldsons said they signed up for HealthNet's Medicare plan because Medicare by itself doesn't cover drugs. But the HMOs say they must reduce drug benefits under those plans because the cost of health care is rising about three times faster than Medicare payments are increasing.

There are drug coverage programs for people with less income than the Donaldsons, and those with more income can afford expensive supplemental insurance.

Congress is considering making it legal for U.S. citizens to buy their drugs from Canada, where they are available at a lower price.

There are also programs to help some seniors with the rapidly increasing cost of drugs. Click here to find out more.


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