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Drugs & Dragons
Don't surrender to high drug costs. Until Congress finally fixes the mess, these strategies can help you beat the system.
By Barry Yeoman
Originally published in Modern Maturity, May/June 2002
IF YOUR TRIPS TO THE PHARMACY have been giving you sticker shock lately, it's not your imagination. Prescription drug prices have been rising at three times the rate of inflation, and consumer spending for medicine doubled from 1995 to 2000. The average retail prescription price now exceeds $45, according to a recent report by the Kaiser Family Foundation. What's more, drug costs increase as we age: Older adults spend more than $700 a year filling prescriptions, almost twice the national average.
Since Medicare does not cover most outpatient prescription drugs, many older adults often do without, filling fewer prescriptions, cutting their doses in half, or taking their daily drugs only when a chronic condition flares up. That's not desirable (to put it mildly).
President Bush and Congress have unveiled several proposals to make prescription drugs more affordable to Medicare beneficiaries (see "What's Mr. Bush Going to Do?", below). Until that happens, there are several options you can try to reduce your medication costs right now:
Contact the drug maker
Many pharmaceutical companies give away free prescription drugs to consumers who can't afford them. Most programs are limited to low-income households, but a handful of the more expensive drugs are available to people with incomes of $30,000 a year or more. The income ceiling for the pricey multiple sclerosis drug Avonex is upward of $60,000.
The catch is that each company has its own distinct application process. And while some manufacturers make it fairly painless, others present "a lot of obstacles," says Rich Sagall, M.D., cofounder of NeedyMeds.com, an information resource for these programs. For example, you may not be able to submit your own application-it may have to go through your doctor. Or you may have to fill out lengthy financial forms.
Once your application is approved, usually you'll receive a three-month supply at a time. When your supply runs out, some companies renew your prescription automatically. Others make you start from scratch. Periodically, companies may also change their eligibility requirements and other rules.
This is all pretty complicated if, like many people, you juggle several medications made by different companies. One way to sort through the different applications is to contact The Pharmaceutical Research and Manufacturers of America, which offers a free directory of patient-assistance programs; log on to get the report as a PDF file, or request a copy by calling (800) 762-4636. Other free online resources are NeedyMeds.com and Medicare.gov (click on Prescription Drug Assistance Programs).
Don't want to go through the hassle alone? For a $5 fee per prescription, The Medicine Program (573-996-7300) will do the research for you, forwarding you the documents you need.
If your prescription isn't covered by such a program, or if you don't meet the requirements of a particular program, Sagall suggests that you contact the manufacturer anyway. You can find a listing in the Physicians' Desk Reference at your local library or through the Internet. In some cases, companies might be flexible enough-or savvy enough about good PR-to make exceptions. "You have to be a little bit persistent," he says. "Don't be discouraged by the guidelines. You have nothing to lose."
In the fall of 2001, Novartis Pharmaceuticals and GlaxoSmithKline unveiled programs that they claim could cut 30 percent or more off the retail prices of their drugs. And in January, Pfizer announced that it would offer its drugs to low-income Medicare recipients for a flat fee of $15 a month for each prescription. Novartis and GlaxoSmithKline are offering their cards to older adults with no drug coverage who have an income of less than $26,000 a year ($35,000 for couples); Pfizer's income ceiling is $18,000 a year for individuals ($24,000 for couples). You need a different card for each company. Contact Novartis at (866) 974-2273; GlaxoSmithKline at (888) 672-6436; and Pfizer at (800) 717-6005.
Try your state government
More than a dozen states have established programs to help needy citizens who don't qualify for Medicaid. You can check your own state by calling the local Area Agency on Aging (the number is in your phone book, or contact the Eldercare Locator at 800-677-1116). To find state programs, log onto the National Conference of State Legislatures Web site. (Click on Public User.)
The state programs vary dramatically. New York's "direct subsidy," for example, pays for some of the cost of drugs for married couples with incomes of up to $50,000, while the cutoff in Minnesota is under $15,000. Depending on where you live, you might have to pay a deductible before the coverage kicks in, you may have a co-payment or co-insurance, and there might be a low cap on benefits.
Some states also offer discount programs, in which the government sets lower prices for older adults-California and Maine have the most far-reaching ones. Where these are in effect, you present a special card to your pharmacist, and the discount is automatically applied to your purchase. Discount cards make it easy, but don't expect the savings to be substantial, says Samantha Ventimiglia, an analyst with the National Governors Association Center for Best Practices. The discount usually comes from the pharmacy's share of the sale, not from the drug company's. And on average, nearly three-fourths of the pharmaceutical dollar goes to the manufacturer, says David Gross, a senior policy adviser at AARP's Public Policy Institute.
Use your military benefits
Retired military personnel and their spouses become eligible for the TRICARE Senior Pharmacy Program when they turn 65, as do survivors of active-duty military killed in the line of duty. Some former spouses qualify too.
TRICARE beneficiaries can obtain their medicines through the National Mail Order Pharmacy. You don't have to enroll in the program; a military identification card is all you need. Simply send in your prescription, $3 for a three-month supply of generics ($9 for brand-name drugs), and a Patient Profile Registration Form. Beneficiaries may request the form by calling (800) 903-4680. You can also visit your local drug store, as long as it's in the TRICARE network, though your costs will triple this way. If you have access to a military treatment facility pharmacy, you can obtain the medicine free.
Before taking advantage of the program, though, be sure to update your address with the Defense Enrollment Eligibility Reporting System (DEERS). You can do this online or by calling (800) 538-9552. If you don't provide your current address, you won't get updated info on the program. For more information about TRICARE, visit its Web site or call (877) 363-6337.
Join a private program
If your income is too high to qualify for support under a state or drug company program, and you're not a veteran, you might want to try a private drug plan. For instance, WellRx charges $25.95 per year and offers discounts of up to 40 percent on prescription drug prices.
Before you sign up, however, review your purchasing needs and the costs of membership to make sure you'll actually save money. Some private programs offer great discounts on generics-but paltry reductions on brand-name drugs. In a study by the U.S. General Accounting Office, private-sector discount cards only brought the price of a 30-day supply of 20-milligram Prilosec to between $115 and $117. (Average cost without the cards in three cities was $121.88.) Likewise, discount cards reduced thirty 200-milligram doses of the arthritis medication Celebrex to between $68.44 and $76.18-not a big saving over its average retail cost of $79.72 without the cards.
If you're enrolled in any of AARP's health insurance plans, you have free access to the organization's Prescription Savings Service, which offers discounts on prescription medicines through the mail or at 46,000 retail pharmacies. If you don't have an AARP-sponsored insurance policy, you can pay $15 a year for an identical service called Member Choice. Both programs offer additional benefits, including telephone consultations with pharmacists and "drug utilization reviews" to make sure none of your medicines interact dangerously with each other. Learn more at www.aarppharmacy.com.
Buy online
Doing this is increasingly easy. You typically place your order online, following simple step-by-step directions, and pay by credit card. The medicine is shipped after your doctor mails, faxes, or calls in your prescription.
The trick is finding the right company to buy from. According to medical experts and the Food and Drug Administration, many Internet pharmacies operate illegally, overseas-out of reach of U.S. law enforcement. You have no guarantee that their products are safe and effective. Instead, order from Internet pharmacies sanctioned by the National Association of Boards of Pharmacy. These are professional operations that follow all federal and state laws. They have licensed pharmacists on call; they protect patient confidentiality; and they follow industry standards for the safe storage and shipping of medicines.
Some of the best bargains are available at www.drugstore.com and www.familymeds.com. For example, Procardia XL, used to treat hypertension and angina, averages $133.81 for ninety 30-milligram tablets at a typical retail outlet. At drugstore.com, you can get the same drugs for $114.34.
Other well-known Internet sites, which are linked to brick-and-mortar drugstore chains, include www.cvs.com, www.eckerd.com, and www.walgreens.com. The National Association of Boards of Pharmacy provides a complete list of online drugstores on its Web site.
If you're planning a trip to Europe, you can find pharmaceutical bargains along the way. Or, if you live close to the U.S. border, plan a day trip to Canada or Mexico. Before you go, make sure your doctor has no objections to your buying medication abroad. Bring a copy of your prescription, and purchase only at licensed pharmacies. Finally, be careful to purchase the correct drug at the proper dosage.
Be creative
In the end, if you find yourself unable to buy the medicines you need, talk to your doctor. There might be a cheaper, but equally effective, alternative to your current regimen. For example, while some arthritis sufferers need to take costly COX-2 inhibitors such as Celebrex and Vioxx, others can suffice with less expensive drugs such as Motrin or Tylenol. Likewise, for digestive problems, perhaps inexpensive H2 receptor antagonists such as Zantac and Tagamet could work just as effectively as pricier proton pump inhibitors such as Prilosec.
Finally, you may be able to cut your costs by buying a higher dose pill and splitting it in half. For instance, if your doctor has prescribed 20 milligrams of Lipitor, you could buy the 40-milligram tablets and split them in half (which could save you around $35 a month).
The key is to be a drug detective: persistent and willing to investigate. You should never be forced to stop taking medicines because you can't afford them. And if you're dogged enough, you won't have to.
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SIDEBAR: What's Mr. Bush Going to Do?
In February, President Bush outlined his fiscal year 2003 federal budget, which included several provisions that would make it easier for older adults to obtain prescription medications at a reasonable cost. The President stopped short of providing details for how Medicare could be expanded to include drug benefits. But he did call for a few first steps:
- Creating a Drug Card program to help older adults get lower prices at the pharmacy. These cards would not be issued by the government, but rather by private companies with the Medicare program's seal of approval.
- Permitting states to provide drug-only coverage to low-income Medicare beneficiaries. This would be accomplished through the Medicaid program or by existing state prescription drug programs.
- Authorizing two new private Medigap plans with prescription drug benefits and catastrophic protection. Currently, only three of the 10 standardized Medigap plans cover medication, and the White House admits that these plans are "prohibitively expensive." Nothing, however, would require private insurers to actually offer the new plans.
Bush's proposal is only the starting point for the debate over prescription drug coverage. This spring and summer, various members of Congress will be unveiling their own proposals, many of them with a higher level of funding than the President's plan. For instance, AARP has called on Congress to pass a $350 billion drug benefit (plus a $400 billion reserve fund).
Although the specifics of each plan were not known at press time, most plans will fall into one of two categories. Some will call for the expansion of Medicare to cover prescription drugs, with the government administering the benefit. Others will call for the drug benefit to be administered through the private sector. Several consumer groups are wary of any measure that would privatize prescription drug benefits. "The reason Medicare was created was because the private market does not serve seniors," says Ben Peck, a lobbyist for the watchdog group Public Citizen.
How to stay informed
Public Citizen and AARP update their Web sites regularly with information about Medicare legislation. Both sites permit you to register for periodic e-mail updates, and AARP allows you to write to President Bush and members of Congress. Also check out a recent three-part AARP Bulletin series on prescription drugs (the May issue examines the money drug companies spend on lawsuits and lobbying).
You can also call the White House directly at (202) 456-1414 and your senators and representatives at (202) 224-3121. Tell them you support legislation to make affordable prescription drug coverage available to everyone with Medicare.
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