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 listserve 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
Tel 914 271-5644
Fax 914 271-6188
