Promoting Access to Affordable, Safe Medications and Healthy Aging

Over 500,000 adults aged 65 and older live in Kentucky today and the number is anticipated to increase as the Baby Boom Generation nears retirement age. Statistics provided by the Kentucky State Data Center project that the 65 and older population will reach almost 650,000 by 2015 and almost one million by 2030. It is therefore critical that we address pressing issues facing our senior citizens now before the population increases and problems become bigger.

We must begin by ensuring a good quality of life for our senior citizens. This includes providing them with access to affordable prescription drugs so they don't have to sacrifice food, utilities or housing to pay for the medications they need. And it includes promoting prescription drug safety to eliminate medical errors and to protect senior citizens from unnecessary harm. In addition, it includes promoting safe and healthy aging by putting policies in place to protect senior citizens from abuse.

My Senior Citizens First plan includes a variety of proposals to support our senior citizens as they age by helping them seek and receive the assistance they need.

I. Provide Affordable Prescription Drugs

Prescription drugs are one of the biggest contributors to the growth in health care costs nationwide. Between 2000 and 2005, prescription drug spending grew faster than spending on hospital care, physician services and home health care. In 2004, Kentuckians spent $3.5 billion on pharmaceuticals. Kentucky could save millions of dollars each year by slowing the growth of prescription drug spending.

In 2005, the average Kentucky senior citizen filled over 35 prescriptions – higher than the national average of 27 prescriptions per senior citizen. Even with the new Medicare Part D benefit – a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries who enroll in the plan – prescription drugs remain out of reach for thousands of Kentucky senior citizens. And there is no sign that prescription drug prices will drop any time soon. In fact, just last year, brand name prescription drug prices increased at about twice the rate of inflation. As Governor, I will provide prescription drug relief for Kentucky's seniors and other citizens by:

Funding the Kentucky Pharmaceutical Assistance Program

The voluntary Medicare Part D benefit has helped over 38 million senior citizens receive prescription drug coverage, according to the Centers for Medicare and Medicaid Services. Yet for some senior citizens who are enrolled, the plan does not provide them with enough coverage and forces them to pay hundreds and possibly thousands of dollars in out-of-pocket costs, in addition to the plan's monthly premiums. These senior citizens fall into what is known as the "donut hole" – a coverage gap.

This is how the coverage gap works: senior citizens covered by Medicare Part D pay their yearly deductible and co-payments for each drug they purchase until their total drug costs reach $2,400. At that point they are required to pay the full cost of their prescription drugs until they have spent $3,850. Once they reach $3,850 in out-of-pocket costs for the year, the coverage picks up again and they are only required to pay their co-payment on each drug for the remainder of the year. Since there are different plans offered under Medicare Part D, deductibles and co-payments may vary from plan to plan.

In 2005 the Kentucky General Assembly passed and the Governor signed a law creating a Kentucky Pharmaceutical Assistance Program. The program specifically was designed to provide income eligible senior citizens in this coverage gap with financial assistance to reduce out-of-pocket costs. It was a bill Dr. Mongiardo co-sponsored. Despite the passage of the bill, funding was never allocated for this program and as a result it was not started. And thousands of older Kentuckians have been forced to pay the price in higher cost prescription drugs.

As Governor, I will provide the leadership needed to fully fund a Kentucky Pharmaceutical Assistance Program and extend the program so even more senior citizens can participate. For example, the original program set income eligibility at 150 percent of the federal poverty level (FPL) and I will raise it to 200 percent of the FPL. My plan therefore will allow individual senior citizens with incomes up to $20,000 (or couples with incomes up to $27,000) to qualify for financial assistance to pay for expenses not covered by Medicare Part D because of the coverage gap. And my plan will cover 75 percent of out-of-pocket costs incurred in the coverage gap.

Developing a Prescription Drug Pricing Website

A 2005 report published by AARP called, Pharmacists' Attitudes and Practices Regarding Generic Drugs, found that pharmacists and customers could benefit from having more information to compare costs of prescription drugs. For example, the study noted that the majority of pharmacists say that it is important to have access to data on drug pricing, benefits and formularies, especially for generic drugs so they can better inform customers. As Governor, I will develop a Prescription Drug Pricing website for consumers and pharmacists to compare commonly prescribed drugs at pharmacies in their cities or counties so Kentuckians can make more informed decisions about prescription drugs and ensure they have the ability to purchase their prescription drugs for the best possible price. A similar website is currently available to New Yorkers and has helped them save an average of $17 per prescription.

Controlling Overall Prescription Drug Spending

Prescription drugs are one of the biggest contributors to the growth in health care costs nationwide. In my Keeping Kentucky Healthy plan, I outlined ways that Kentucky could save millions of dollars each year by slowing the growth of prescription drug spending, including implementing e-prescribing, promoting evidence-based drug purchasing and expanding access to discounted 340B drugs. As Governor, I will work to aggressively control prescription drug prices to reduce health care costs overall and to provide relief to Kentuckians, especially our senior citizens.

II. Ensure Prescription Drug Safety

In addition to proposing programs and services to make prescription drugs more affordable for Kentucky senior citizens, a Beshear/Mongiardo Administration also intends to institute policies to ensure prescription drug safety such as:

Promoting E-Prescribing to Eliminate Medication Errors

Kentucky senior citizens deserve access to affordable medications that are safe for them to take. Unfortunately, senior citizens are especially vulnerable to medication errors, such as taking the wrong combination of drugs or having the wrong drug or dosage prescribed. Electronic prescribing (e-prescribing) is one of the most promising methods we have to eliminate medication errors. E-prescribing is an electronic prescription order that can be sent directly from the patient's physician to the pharmacy where the prescription is filled. It provides real-time information about the drugs a patient is taking, thereby reducing harmful drug interactions and helping prevent duplicate prescriptions. By reducing medication errors, e-prescribing also can help contain health care costs overall. It works best when every health care provider, pharmacist and hospital is using e-prescribing. In my Keeping Kentucky Healthy plan, I stated my commitment to e-prescribing and noted that some of the start-up costs for statewide e-prescribing could be drawn from the non-profit partnership I will form as part of our 21st Century e-Health effort. To jump-start this initiative as well others intended to eliminate medication errors described in my plan, as Governor, I will set aside $5 million each year from revenues generated through expanded gaming. I believe there is significant potential to reduce medical errors, especially among our senior citizen population who represent the largest group of prescription drug consumers.

Using Technology to Manage Prescriptions

In my Keeping Kentucky Healthy plan, I described innovative ways states are using technology to better manage prescriptions in their Medicaid programs and preventing harmful drug interactions and saving millions of dollars. For example, Florida equips doctors who prescribe a high number of prescriptions with handheld devices that show their patient's real-time medication history. With this information at their fingertips, physicians can make more informed prescribing decisions, resulting in fewer medical errors and fewer drugs needed, and yielding a two-year savings of $50 million. As Governor, I will pursue opportunities to use technology to better manage prescriptions and ensure patient safety.

Launching a Know Your Pills – Save Your Life Campaign

It is critical for senior citizens to know the medications they are taking and their recommended dosages so they can accurately relay the information to their health care providers, especially in an emergency. As Governor, I will launch a Know Your Pills – Save Your Life campaign to:

• Educate senior citizens on the importance of knowing their own medical history and medication information,

• Assist the medical community fulfill their required role to document the medications taken by their patients to reduce medication errors, and

• Help emergency services personnel quickly seek the information they need about the medications a person is taking by knowing what kinds of questions to ask.

As Governor, I will partner with the medical community to design and distribute personal medication cards to every Kentucky senior citizen. I will request assistance from our senior citizens by asking them to fill out a medication card listing their medications and recommended dosages with their doctor's and/or pharmacist's assistance. The cards will be used to establish an accurate record of a patient's medications that could be carried with them at all times and in case of an emergency.

III. Promote Safe and Healthy Aging

We also must implement policies that promote safe and healthy aging. For example, senior citizens and their families should feel secure knowing that if they or their loved one falls ill and requires nursing home care that they're receiving the best care possible. In addition, we must put in place programs that protect senior citizens from becoming victims of crime. That is why a Beshear/Mongiardo Administration will seek the following senior citizen protections:

Creating a Nursing Home Report Card

Families across Kentucky face the important decision of whether to place their loved one in a long-term care facility like a nursing home every day. Families need information to guide them in deciding the best option for their elderly family members that ensures they will receive the care they need in a safe and quality environment. That is why, as Governor, I will work with the Office of Aging Services to develop a quality rating system that will be used to evaluate nursing homes and publish this information in the form of a report card. The rating system will be based on routine reviews done by licensed inspectors who are charged with ensuring nursing homes meet the quality standards set by the federal and state governments. The nursing home report card will be accessible on the Internet through the Long-Term Care Ombudsman program and KYCares – an online service that helps consumers find the information they need. In addition, nursing homes cited for three or more deficiencies in two consecutive years will go on the "nursing home watch list" and will be targeted for unannounced inspections, inspections on weekends and during evenings and subject to more frequent inspections until the deficiencies are corrected.

Preventing Cases of Abuse in Nursing Homes

One of the best ways to protect senior citizens from becoming victims of abuse is to ensure they receive care from qualified, well-trained and reputable nursing home staff. For example, Louisiana requires criminal background checks of all nursing home staff. Moreover, Illinois recently became the first state in the country to institute a law requiring all nursing home residents undergo a criminal background check to protect the well-being of its residents. As Governor, I will adopt similar measures in Kentucky's public nursing homes and long-term care facilities to prevent the chance of abuse. In addition, I will also put in place better protections for employees and residents who report cases of suspected abuse to shield them against retribution.

Calling for Tougher Elder Abuse Laws

A recent study by the National Center on Elder Abuse concluded that only 16 percent of cases involving elder abuse are ever reported. That means that the frequency of elder abuse is likely much higher than the 3 to 5 percent of all senior citizens figure often cited. In addition, as the population aged 65 and older grows so to will the prevalence of elder abuse and exploitation. Although Kentucky already has some laws to protect against elder abuse, at least one – the protective service law – does not go far enough. Kentucky's current protective service law (§209.020) defines abuse in three broad categories:

1. Abuse: The infliction of physical pain or injury, mental injury or injury of an adult.

2. Exploitation: The improper use of an adult or an adult's resource by caretaker or other person for the profit or advantage of the caretaker or other person.
3. Neglect: A situation in which an adult is unable to perform or obtain for him/herself the services which are necessary to maintain his health or welfare, or the deprivation of services by a caretaker which are necessary to maintain the health and welfare of an adult, or a situation in which a person deprives his spouse of reasonable services to maintain health and welfare.

Other states like Alabama, California, Florida and New York have instituted new laws to protect senior citizens against other forms of abuse such as sexual abuse, emotional abuse, financial abuse and isolation and/or intimidation. As Governor, I will review Kentucky's elder abuse definitions and laws and identify opportunities to strengthen them.

Establishing a Financial Exploitation Guard

All too often senior citizens are victims of unscrupulous lenders who seek to rob them of their savings. It's time for Kentucky to take stronger action to prevent senior citizens from being preyed upon by people and businesses that profit from these heinous acts. New York is one state that is doing something about it. They have established a Financial Exploitation Task Force that brings together representatives from various private and public agencies and organizations to inform and educate financial institutions and consumers about financial abuse. The program provides training and outreach services and operates under the principal that knowledge is power. As Governor, I will establish a similar initiative called the Financial Exploitation Guard whose purpose will be to alert older Kentuckians about ways to protect themselves from deceitful lenders and train financial institutions on how to identify and report people or businesses suspected of fraudulent lending practices.

Creating a Money Match Assistance Program

In partnership with the local AARP chapter, Pennsylvania created a money management program to help older, low income, disabled Pennsylvanians manage their money more effectively. The program matches trained volunteers with consumers in need of financial assistance to help prepare a budget and make sure bills are paid on time. As Governor, I will work with our consumer advocates on aging to develop a similar program in Kentucky to assist our low income seniors and those in need of financial assistance receive the support they need.

Conclusion

Kentucky needs a leader who will work to improve the lives of senior citizens and fight for protections to safeguard them from becoming victims of abuse. A Beshear/Mongiardo Administration is committed to doing both.

For a complete list of references, contact Vicki Glass at vicki@stevebeshear.com.