The Growing COPD Crisis in America

COPD Medicare coverage

What is COPD?

Chronic Obstructive Pulmonary Disease is a progressive disease that causes difficulty in breathing, frequent coughing, wheezing, and tightness in the chest- and that includes emphysema and chronic bronchitis. It affects more than 30 million people in America.

The Financial Burden

Given the amount of medications (one to two inhaled medicines, oxygen and BiPAP therapy in some cases) needed to treat this condition, it is hard for both patients and the Medicare system to keep up with the costs. COPD is mostly caused by smoking, with the exception of about 25% of cases.

Due to increasing prices of drugs, and many patients being on more than one inhaler (even on Medicare), patients are struggling to pay for their medications, driving them into the “donut hole” of coverage.

The costs of medicines for COPD are among the most spent on prescription drugs under Medicare. To save money, some COPD patients do not take as much of the drug as prescribed per day, and some rely on free samples from their doctors or order from overseas.

Exacerbations Can Lead to Hospital Stays

It is important for patients to stay on their inhalers to prevent a flare or attack that could send them to the emergency room. Acute exacerbations of COPD can lead to hospital readmissions, and readmission rates are high for COPD patients. Exacerbations can lead to death as well as large financial burdens.

Quitting Smoking and Pulmonary Rehab

The first step if diagnosed with this disease is to quit smoking. Medicare Part B covers up to eight face-to-face smoking cessation counseling sessions in a 12-month period. Medicare Part B also covers pulmonary rehabilitation programs with doctor referral. These programs helps those with COPD with exercise, education, and support to help them learn to breathe and function at their best. Patients also are able to form communities with others with the disease. Patients must be referred by a doctor and take a pulmonary function test using a spirometry device.

National Action Plan, Tips for Coping

In response to the growing COPD crisis in our country, the National Heart, Lung, and Blood Institute (NHLB) has just released a COPD National Action Plan. This plan aims at ending COPD in the U.S. by empowering patients, equipping doctors, analyzing data, increasing research, and taking action.

In the meantime, some tips for coping with COPD include quitting smoking, learning simple breathing exercises, doing gentle exercise, maintaining a healthy weight, eating well, and having a plan in place in case you experience an exacerbation.

What Medicare Covers

As far as COPD treatments, Medicare Part B covers:

Medicare Part D covers prescriptions, however, as noted earlier, the cost can still be high for the amount of medications needed for COPD. Consult with your doctor for more information.

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