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Special coverage: Medicare

Costly drug law may create long-term savings

By TOM VALEO
Published October 30, 2005

The new Medicare prescription drug law will be extraordinarily expensive, but it also could produce significant savings if it persuades more elderly people to take the medications they need to curb four of the major problems that afflict the aging body: high blood pressure, high cholesterol, congestive heart failure and diabetes.

Currently in the United States, many elderly forgo these drugs because they are expensive. Researchers at the Harvard School of Medicine, for example, found that elderly people with incomes of less than $10,000 used fewer than half as many prescription drugs as did those with drug coverage. However, this attempt to save money by not taking prescription drugs can lead to greater costs later. Without high blood pressure medication, for example, people are more likely to suffer a stroke or heart attack, which require costly hospitalization and therapy.

That's why the new Medicare drug law has the potential not only to improve the health of the elderly, but to lower Medicare costs somewhat.

Drugs that control high blood pressure are among the most important for protecting the health of the elderly. New guidelines from the National Institutes of Health encourage people to keep their blood pressure below 120/80 in order to minimize their risk of heart disease, stroke and other complications.

Losing weight and increasing exercise can help keep blood pressure normal. Some people, especially African-Americans, benefit from taking low-cost diuretics, which reduce the volume of water in the blood, thereby reducing pressure on the artery walls. But 90 percent of people who, at age 55, do not have high blood pressure, will eventually develop it, according to the National Institutes of Health, and may need two or more medications to keep their blood pressure under control.

The new Medicare drug law could be instrumental in helping lower-income elderly obtain the medications they need, and thereby avoid the complications of high blood pressure. Statin drugs, which lower high cholesterol, are expensive, and many elderly who need them don't buy them, or skimp on the dose to make the drug last longer. But statins are proving to contribute to good health in a variety of ways.

Keeping LDL low discourages cholesterol from collecting on the artery walls and constricting blood flow. Even when started later in life, when some plaque has already formed, statins slow further accumulation and may even reduce the size of some obstructions. In addition, statins reduce inflammation in the artery walls. Inflammation can cause artery walls to rupture and release pieces of plaque into the bloodstream, where they can block an artery, causing a heart attack or stroke.

Congestive heart failure, which used to be a death sentence, is now readily controlled with medications that dilate the blood vessels, remove excess fluid from the blood and strengthen the heart's pumping ability. Combinations of these medications can be costly, but using them as prescribed can reduce hospitalization and complications from congestive heart failure.

Finally, diabetes can be a very expensive disease because it brings on a host of complications such as blindness, heart disease, kidney failure and amputation. But the drugs needed to control diabetes itself are not particularly expensive.

Still, many of the elderly either fail to get screened for diabetes and don't know they have it, or, if they have a mild case, don't take the drugs they need to help their body absorb glucose.

The Medicare drug benefit will be expensive. When passed, the Bush administration promised the benefit would cost $400-billion over 10 years, but recent projections predict it will cost three times as much - a staggering $1.2-trillion - in part because the bill prohibits the government's negotiating with drug companies for lower prices. Still, prescription drugs are a very cost-effective way to treat many of the problems of aging, so some of the cost of the prescription drug law will certainly be offset by savings on expensive treatments.

-- Tom Valeo is a freelancer who writes about medical and health issues. Write to him c/o Seniority, the St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731 or e-mail features@sptimes.com

[Last modified October 28, 2005, 14:27:02]