The PRICE clinic for low-income elderly: a managed care model for implementing pharmacist-directed services. J Manag Care Pharm

he elderly are particularly burdened by rising pharmaceutical costs, which grew to $162.4 billion in 2002, an overall increase of 15%.1 Older patients suffer from high rates of chronic disease, and ongoing drug therapy is often essential.2 Thus, most elderly people must adhere to multiple drug regimens. A study of adults older than 60 years found that these individuals take an average of 5 prescription medications per day, 3 times as many as the general population.3,4 Drug expenditures reflect this high use, as elderly patients incurred, on average, $2,322 in drug costs in 2003, of which $999 was paid out of pocket (OOP).5 Drug spending shows no signs of slowing, and in 2006, Medicare beneficiaries are expected to incur an average of $3,160 in annual drug expenditures, of which $1,454 (46%) will be paid OOP.5 Because nearly a quarter of Medicare recipients live on less than $600 per month, increasing drug e x p e n d i t u res impose a particularly heavy burden on low-income elderly people.6 In a survey of 10,416 elderly patients, 22 % of respondents stated that they skipped prescription doses or did not buy the medications they needed because the cost was too high.7 Another study found that two thirds of 660 chronically ill, older adults cut back on their prescription drugs because of difficulty paying for them, but they did not tell their doctors before they did so; furthermore, 35 % never told their doctors.8 The Medicare Modernization Act of 2003 is intended to help elderly patients aff o rd the rising costs of drugs. The legislation, which will cost an estimated $724 billion over 10 years, will offer a drug benefit package and subsidize the participation of health maintenance organizations (HMOs) and other private entities in the Medicare market.9, 1 0 The govern m e n