With senior citizens struggling to afford their prescription drugs, a Warwick state representative proposes to expand the state’s pharmaceutical assistance program to cover all medical illnesses. Expanding the Rhode Island Pharmaceutical Assistance to the Elderly program would boost the cost of the $6 million program by $1.65 million in fiscal year 2001 and by $3 million in fiscal year 2002, according to the state Department of Elderly Affairs.
But Peter T. Ginaitt, a Warwick Democrat, argues that by covering all, rather than select illnesses, the state will be able to keep track of all the medications that a RIPAE beneficiary is taking. And this, he said, will allow it to do a better job of spotting things like contraindica-tions, instances when a certain drug would have a negative impact on the elderly. With more thorough drug ‘utilization review,’ as it’s called, the state should be able to cut hospital stays, and improve the health of the senior citizen population overall, Ginaitt said.
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RIPAE, created by the General Assembly in 1985, covers 31,000 Rhode Islanders. It is funded through state appropriations. Every company that provides a drug for the RIPAE program signs a rebate contract with the state. The contract requires the manufacturer to give the state a 26 to 28 percent rebate for the money the state spent on prescription drugs with that manufacturer under the program.
The cost increases the department projects accounts for the rebates the state will receive. It also assumes that the program’s other requirements, such as age and income restrictions, stay the same.
Initially, RIPAE provided prescription drug subsidies for diabetes, hypertension, and heart conditions only. But the General Assembly has added illnesses to the program over the years.
Right now, RIPAE covers prescription drugs used to treat: Alzheimer’s disease, depression, diabetes, high blood pressure, high cholesterol, heart conditions, glaucoma, Parkinson’s disease, cancer, circulatory insufficiency, respiratory conditions, urinary incontinence, prescription vitamins, and mineral supplements for renal infections.
The state pays 60 percent of the cost of prescription drugs for these conditions; the patient pays the rest. To qualify for RIPAE, a citizen must be 65 or older, have exhausted his or her managed care prescription drug benefits, and meet income guidelines. For a single person the income limit is $15,558; for a couple it’s $19,449.
But the program does not cover, for example, the cost of antibiotic therapies, even though pneumonia is one of the leading reasons that low-income senior citizens end up in the hospital, said Barbara A. Rayner, director of the state Department of Elderly Affairs. Therefore, expanding RIPAE to cover all illnesses – going to an “open formulary” – would be a positive step, especially given that most prescription drugs in the United States are consumed by older Americans, she said.
”The intent is to expand access, and to ensure access to the resource of medicine,” Rayner said.
Ginaitt, a Warwick firefighter who works on Rhode Island’s second-busiest medical rescue team, said he often responds to emergency calls in which the victim has failed to take his or her medicine properly, or has failed to take it at all. In seeking to expand the program, Ginaitt said he hopes to expand RIPAE’s drug utilization review processes.
Under RIPAE’s current program, the state contracts with an outside company, MIM Health Plans Inc., a pharmacy benefit management company based in Elmsford, N.Y., to administer the drug utilization review. When a patient presents his or her RIPAE card to the pharmacist, a computerized program checks to see if the drug the patient is attempting to get is covered by RIPAE. Then it checks to see if the prescribed drug would have a negative impact on an elderly person; whether that drug would have a harmful interaction with another drug the patient is taking; and whether the patient is attempting to fill the drug too soon.
If any one of these cases exist, the pharmacist will be notified, on-line, that he or she may not dispense that drug, said Dennis Costa, who manages the RIPAE program for the department. A doctor may override the MIM notice, he said.
The problem is that the patient may be taking prescription drugs for an illness that RIPAE does not cover. And if the pharmacist does not know about all the drugs a patient is taking, it becomes difficult to accurately assess his or her mix of medications. This is a problem because the prescription drug misuse – not abuse – is a common problem among the elderly, Rayner said.
”The only prescription drugs the pharmacist may be aware of are the drugs that are being purchased through RIPAE,” Rayner said.
”We’re not entitled to know what (drugs) they buy privately,” added Ginaitt, who said he would also like to explore the possibility of reducing the RIPAE age minimum from 65 to 55. An investment in RIPAE now will lead to reduced costs later, he added. “The whole system can start to feel the effect if we keep these people healthier.”
Experts note that the issue of affordable prescription drugs is particularly salient to Rhode Island. With 157,000 residents age 65 or over – out of a total population of just under one million – the state, proportionately, has the third highest elderly population in the nation. Ginaitt noted that RIPAE program was among the first of its kind in the nation, and has since served as a model for other states.
The Rhode Island program already works well, but that does not mean the state cannot do more. “All good cars need a tune up now and again,” he said.
