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ZNET commentary, December 26, 2000
By Dorothy Guellec

Drug companies are giving away medications if you know how to ask. This is the best-kept secret because it is not widely known. All of the top 30 pharmaceutical companies make prescriptions available free, and these programs are horribly underutilized. PHRMA, an industry trade group, told me that 2.8 million prescriptions nationwide (not including samples) valued at about $500 million were given away in 1998.

Getting prescriptions to the people who need them is vital nowadays. Costs are rising and, contrary to the mainstream media stories, few older citizens can just hop on a bus and go to Canada for a prescription every 30 days. There are several vehicles physicians can and should use to make sure needy patients get prescriptions. "We have a responsibility to care for the poor," said Herbert Rakatansky, MD, chair of the AMA Council on Ethical and Judicial Affairs.

I spoke with Bob Huber at Pfizer on December 9th, 2000. He told me that after the merger with Warner Lambert this summer, the combined companies' projected earnings for this next fiscal year would be $30 billion and of that, $5 billion would go for research and development. I asked about the other $25 billion, but he just laughed.

Of the patient population most dependent on medications - those older than 65-31% lack coverage for prescription drugs. Seniors who have coverage typically use 21 prescriptions a year. About 45% of the elderly have incomes at 200% or less of the poverty line. That's $16,000 to $18,000 a year before taxes. The average senior citizen today has 2 to 2 ½ chronic conditions, and a drug just for one chronic condition can cost between $500 and $3,000 a year if bought in the U.S. Of course one could always go to India and purchase a copycat for 1/50th the price. Trying to understand the regulations is very tricky as the pharmaceutical companies are not forthcoming, just the opposite. The drug companies will not discuss criteria; believe me I've tried. Patient-advocacy groups say they have seen families with incomes of $50,000 or more get free prescriptions.

Most programs require the patients to apply through their doctors. The doctors are not informed because generally it falls to the sales reps to promote the programs. In today's climate, with the average doctor allowing 10 minutes per patient, one can understand why doctors are not aware of these benefits. To qualify, applicants must show they have no coverage for outpatient prescription drugs; that their income must be low enough that paying for medicine would pose a hardship; and that they do not qualify for Medicaid. In reality the doctor writes a two-sentence letter to the pharmaceutical company without any other documentation. Most companies supply three months at a time on a case-by-case basis.

The corporate drug programs are underutilized. I see this as political not philanthropic. They want to keep it a secret. They do it so they can tell Congress, "We give away medicine for free," but then, they don't tell anybody about it and make it very hard for people to apply. After researching this program for hours, I came up with one article from the Wall St. Journal and a few stories from local mid-western papers. Actually the Journal article described the program as being "difficult to apply for."

This isn't true. Every company has guidelines and some require lengthy paperwork, but not uniformly. There is a non-profit organization called the Medicine Program that can help to simplify the process in some cases, but I would advise patients to first try on their own. Dan Hogg of the Medicine Program said, "We just serve as the patient's advocate." For $5, refundable if you do not qualify for the free drugs, this non-profit organization will help with the paperwork and get them to the right pharmaceutical company. Most pharmaceutical programs look at income and expenses and do not count assets, which can often disqualify people from government programs. Last year Glaxo Wellcome gave away $28 million in drugs, it fills more than 14,000 free prescriptions each month.

The Medicine Program's website is www.themedicineprogram.com. It appears strange that they claim to be non-profit with a com., and not org, but buyer beware I guess.

Physicians should be aware that a large number of people might have difficulty affording a drug without insurance coverage. Doctors are obligated in my opinion, to advocate for their patients. They should get involved and help to access medications. Some physicians feel that there are limits to their obligations. One said, "While physicians have a responsibility to help care for medically indigent patients in a variety of ways, using their own financial resources to make that happen is above and beyond the call of duty." Doctors, however, agreed that their implied social contract calls on them to help needy patients. I wonder if they feel that ensuring that patients obtain prescription drugs is part of that contract.

Handing out free samples from the manufacturers is the easiest option, but the industry opposes this - I wonder why. Of course it's not a long-term solution for patients with chronic conditions. A more viable option is the patient assistance programs. If physicians cannot keep on top of what pharmaceutical companies offer, then its up to the patients . Can't lose anything by asking. Pfizer Inc. is relies on the physician's word not the patient's tax forms.

Libby Overly was working as a home health social worker in Alabama when she recognized that the personal database she'd developed to navigate the patient assistance programs might encourage doctors to access them as well.

With the help of Richard J. Sagall, MD, she created Need Meds, an online database of companies and the free drugs they offer. Patients can also access a Directory of Drug Patient Assistance Programs by PhRMA a trade group for the pharmaceutical industry. It is a handy directory of 33 companies who provide drugs to physicians for patients who otherwise could not afford them. Of course ultimately society has the responsibility to make sure that people have access to all the health care they need.

The prestigious AARP devoted their November publication "Bulletin" to the array of problems that their sample of 11,000 members might encounter. Not once did they mention the Prescription Assistance Program. What is one to think? It is obvious that the top honchos do not want all the members of AARP asking their doctors for free medicines. A psychiatrist on a listserv wrote "many of my patients are provided medications through pharmaceutical company patient assistance programs.these provide for 2-3 month supply of meds for uninsured, low income patients. I rarely have had any patient turned down and have never had a patient taken off the program, unless of course they obtained insurance. My routine and the routine of many doctors in my clinic is to begin a patient on samples and then, once you find that the medication is working for the patient, transition them to the patient assistance program." The natural question to wonder about is why is this doctor so well informed, and most of the others are not? Is it not incumbent upon them to know about these programs? Maybe it's the fault of the drug reps., but if the reps can only see the nurses, or have 5 minutes with a doctor to explain a new medication, when can they promote patient assistance programs?

It finally and logically falls to the media, and the pharmaceutical companies themselves, to promote these programs vigorously. I did a very thorough search and spoke with lots of so-called informed people - they never heard of free medications from 33 of the leading companies. There are about 980 pharmaceuticals amongst all the companies, and new ones are being added all the time.

Anyone reading this is encouraged either to email me, or to insist that the doctor or someone on his or her staff research the availability of the medication. The chances are that there is at least one non-generic (expensive) drug that is available free of charge.

Dorothy Guellec
guellec@purvid.purchase.edu
Tel 914 271-5644
Fax 914 271-6188

Posted by pnhp at 10:35 AM | Permalink | Comments (1)

USA TODAY
December 20, 2000
Page 12A

Some health-insurance woes can be avoided.

The health insurance industry told the public and employers that they could provide medical care for less money, and many purchasers of medical-care insurance bought into that (''HMO: What happens after the Band-Aids run out?'' Cover Story, News, Dec. 8).

What the insurance companies didn't tell people about were the long waits for appointments, crowded waiting rooms, shortened hospital stays, delayed or limited specialist services and even actual denial of services and procedures.

Now that the insurers have squeezed the hospitals and doctors as much as they can, they are raising premiums. Medical costs are rising as medical technology improves and as the population ages and needs more medical care; but the insurance industry has cost burdens that can be avoided. Medicare operates at an administrative overhead of less than 3%. The time has come to get rid of the health-insurance industry, its multiple, redundant administrations, costly marketing, obscene executive salaries and the need for corporate profits.

By eliminating these expenses, this country could afford Medicare for all through a proven single-payer system. There would be a single set of rules to abide by. Everyone would have medical coverage, and patients would be able to choose any doctor or hospital they wanted to use.

Melvin H. Kirschner, M.D.
Family Practice
Van Nuys, Calif.

Posted by pnhp at 03:31 PM | Permalink | Comments (0)

By Joan Retsinas
The Progressive Populist

Dear Santa,

It's time for my annual letter to you. Fresh from giving thanks for all the bounties of prosperity at Thanksgiving, I am compiling my wish list for more bounties. That is the schizoid nature of this season: gratitude followed by greed.

But I'm unabashedly making my same old request: universal health insurance -- a one-card system that gives every American access to our wonderful doctors and hospitals (thank you for the wonderful doctors and hospitals). European countries have this. I want it too.

I know. I know. I've asked you for this before. In 1935. In 1946. In 1950. In 1965. Eight years ago. And each time I semi-graciously acknowledged that the time wasn't right. In 1935 Social Security was a big enough holiday gift -- the greediest citizen couldn't expect you to tack on health insurance too. In 1946 you gave hospitals a mammoth boost with Hill Burton legislation -- thanks to you, Congress pored millions of dollars into hospital construction throughout the nation. It was too much to expect, as some senators did, that you could give us a health insurance package too. In 1950 I put it on my wish list -- you got President Truman to talk about it. But no go. In 1965 you gave us a partial gift -- universal health insurance, but only for the disabled and elderly. Again, I'm grateful, but still want more. As for 1992, maybe the whole shebang -- health insurance for everybody -- was just too much to ask for. Greedy aspirants generally get coals in their stockings, don't they? But it has been eight years, and I'm weighing back in with the same old same old.

This time you are my last recourse. I've given up on the new President -- neither the Democratic nor the Republican candidate promised universal health insurance during their campaigns, and they promised lots of other goodies. Senator Bill Bradley, the only Presidential candidate to float a detailed proposal for national health insurance, didn't survive the primaries. Congressional solons are not waxing hysterical about the persistent pool of people without insurance. Why should they? Our elected leaders all have health insurance by virtue of being in Congress. And all are wealthy enough to buy insurance on their own if their constituents dump them -- a rare occurrence in American politicaldom.

So, Santa, I'm bringing my cause to you.

I know that most Americans have dropped "health care" from their annual wish lists. In a post-voting poll, a sample of voters named their key desire (aside from character, which the pollsters took off the table). Most (24%) want to save Social Security (though it is in no imminent danger); 23% care about education; 16% care about abortion; 13% about taxes, 12% about the economy (which -- thank you -- is roaring along superbly). Only 11% put "health care" at the top of their wish list; and some of them are asking you for prescription drug coverage.

But the 43 million of us who lack insurance are a tenacious lot. In general, we haven't been especially good or especially bad this year -- certainly not bad enough to end up waiting in hospital emergency rooms, hoping on the one hand that we are sick enough for somebody to look at us, hoping on the other hand that we aren't truly that sick. We don't deserve our plight. Most of us work, earning just enough to fall into that oxymoron category, "the working poor." Either we have the bad fortune to work for employers who don't offer health insurance as a fringe benefit. Or we can't afford to buy the insurance that our employers do offer.

Santa, you have dropped "health care stuffers" into our holiday stockings in past year. We have COBRA, which lets us, or our families, buy insurance at our employer's group rates if we leave the job. That helps -- thank you -- but few people can afford to pay even the group rates, especially people who have lost their jobs. Medicaid now enrolls children, and, in some states, their parents, whose income falls above strict Medicaid levels. That too helps. We have special funds to pay for breast cancer treatment for uninsured women diagnosed with breast cancer -- again, thank you.

Those stocking stuffers, though, don't suffice. We still want the whole shebang -- a "health insurance card," like the Medicare card all Americans get when they reach age 65. You can take back COBRA, Medicaid, and the special programs for special populations. We won't need them anymore.

Sincerely,

An Ever-Believing Virginia

Joan Retsinas is a sociologist who writes about health care in Providence, Rhode Island.

Posted by pnhp at 03:31 PM | Permalink | Comments (0)