Psst. The real scoop on Patient Assistance Programs


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

Guellec

[email protected]

Tel 914 271-5644

Fax 914 271-6188

 

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