Wednesday, September 26, 2001

Cost of the cure

Increasingly, too much about the profession of "healing" is measured in terms of dollars and cents. As the cost of living rises, so does the cost of treating patients, and of caring for one's own health.

The cost of medication has increased to such a degree that some patients cannot afford to pay their monthly pharmacy bills and eat, too. Patients who must take numerous medications daily, and whose medications include experimental drugs or drugs that can cost $2-3 per pill, are among those hardest hit. For example, Prevacid, a medication commonly given to persons with Gastric Esophageal Reflux Disease (GERD) costs more than $3 per pill.

There are generic (non-brand name) substitutions for most medications; and yes, they are much cheaper than the brand name item. But what happens when only the brand name drug is able to help the patient's condition (according to his/her physician), or when there is no generic substitute for the medication a person is taking?

Unfortunately, there are many people who are without medical insurance, are under-insured (policy does not pay for medication, or does not cover the medicines that the person needs), or who for some reason do not qualify for government programs like Medicaid, Cancer State Aid, or Peachcare (insurance for children). We might also take into account those who live on a fixed income (i.e. Social Security).

Even if a person does have some type of insurance, co-pays and charges for medications not listed as "covered" by individual companies can add up to hundreds, and in some cases thousands, of dollars a month. Thankfully, many drug companies have programs designed to assist those most affected by, yet least able to afford, the high cost of medications. These programs provide free medications to individuals who qualify.

All such programs base eligibility on income and insurance status, which means that the applicant must show a need for medication assistance. Each participating drug company has its own application paperwork and process, and requires the participation of the prescribing physician.

The various drug manufacturers who sponsor these programs make decisions about which medications are offered free of charge, what their eligibility criteria is, and which applicants are accepted. Individuals with family incomes ranging from below the national poverty level up to $50,000 annually can qualify. Those qualifying at the highest income levels are generally AIDS patients requiring very expensive drugs.

For an individual who takes several medications, the process of figuring out which company manufactures each drug, and which of the identified companies has a drug assistance program, then contacting each for an application, can be complicated and overwhelming. However, The Medicine Program is a program that does all the legwork for the applicant.

They provide a simple form, which the applicant fills out and mails in with a processing fee of $5 per medication requested. The program takes the information provided and (according to their pamphlet) "builds a customized packet, which describes the specific steps to be taken by the patient and the doctor to proceed with the application process. When these steps have been accomplished, the completed application(s) are sent to the appropriate manufacturer to be considered. If the patient is approved, within 2-3 weeks the medications are normally sent to the physician's office to be dispensed to the patient."

The Fayette County Health Department has pamphlets for The Medicine Program on hand. On the other hand, if you have computer access, you can download the information from the Web at www.themedicineprogram.com.

If you prefer to do the research yourself, there is an excellent resource entitled The Directory of Prescription Drug Assistance Programs 2001-2002. The Pharmaceutical Research and Manufacturers of America (PhRMA) produce this information. It too is available at the health department, or online at www.phrma.org/patients/.

Let your physician's office know of your financial situation and ask them if they have any information about medication assistance programs. You might also ask your doctor to let you try samples of a new medication to see if it will provide the desired results before writing a prescription for it. Or request that your pharmacist fill only half the prescription until you and your physician can determine if a new medication is right for you.

No one should ever have to choose between buying food or needed medications. Medication assistance programs seek to free up family income vital to maintaining the necessities of life (food, shelter, etc.), by providing medications vital to the health, and sometimes very life of the individual.

These programs will help if you do not have insurance coverage for outpatient prescription drugs; have an income that is at a level that causes a hardship when the purchase of medication at retail cost is required; or do not qualify for a government or third party program that provides for prescription medication.

You my pick up The Medicine Program pamphlets (containing applications), and/or a copy of the PhRMA directory at the Fayette County Health Department, 140 Stonewall Ave West, Suite 107, Fayetteville, GA. For questions, please call us at 770-461-1178, ext. 5416.