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Rx for Pricey Drugs: Assistance Programs and Bargain Prices

Drugmakers and retail chains offer meds at bargain prices. But are they worth it?



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American households annually spend more money on health care than on education and entertainment combined, with more than $200 billion alone going toward the purchase of prescription drugs, according to The Kaiser Family Foundation, a nonprofit health care research and communication group.

As health costs and unemployment soar (an estimated 45 million people in the U.S., including eight million children, do not have health insurance, according to the U.S. Census Bureau), it has become ever tougher for people to afford medical treatment, forcing some to not to fill prescriptions or to skip doses, thereby reducing therapeutic benefits as well as upping the opportunity for antibiotic resistance, according to Kaiser.

In an effort to increase access to prescription drugs, retailers and pharmaceutical companies are increasingly offering medicine at dramatically lower price tags and, in some cases, free of charge.

Discount giants Target and Wal-Mart in 2006 began selling 30-day supplies of generic prescription drugs to customers for $4 (and K-mart for $5); for a 90-day supply, the chains charge about $10. The low-cost program began in a handful of their stores but is now available in all of their locations with pharmacies. Some local supermarkets with pharmacies, meantime, are now providing generic brand antibiotics at no cost.

Some drugmakers have been offering free and reduced-rate prescriptions for decades to those who qualify based on financial need. They also hand out about $16 billion worth of free prescription samples to doctors each year. Many consumer advocates and physicians have applauded the results.

"Anything that helps anyone afford their prescription drugs is a good thing," says Cheryl Matheis, a senior vice president for health strategy at AARP, a membership organization and advocacy group for those 50 years of age or older. But, she says it will take a lot more to fix the nation's health care woes. "You can relieve the symptom, but you're not really attacking the problem," of millions of Americans who are struggling to pay for food and shelter—let alone their meds. "It's a Band-Aid approach to an issue that's growing."

Some experts also bring up health concerns about dispensing antibiotics at low or no cost, which they fear may lead to overuse and add to the growing problem of "superbugs" that have developed resistance to some antibiotics. The reason, says Laurie Hicks, a medical epidemiologist at the U.S. Centers for Disease Control and Prevention (CDC): physicians may be more easily swayed by insistent parents to prescribe free antibiotics even though a kid has a viral (as opposed to a bacterial) infection for which such drugs are useless.

A study published in the American Journal of Public Health (AJPH) in 2008 found that the bulk of free samples were distributed to patients who already had insurance coverage and were more likely to be able to purchase a prescription of the drug.

Help from the Makers  In spring 2005, the industry group Pharmaceutical Research and Manufacturers of America (PhRMA) launched a service called the Partnership for Prescription Assistance (PPA), which provides information about hundreds of private and government programs that can help low-income patients fill prescriptions for little or no cost. According to Kaiser some 41 percent of the 1,659 adults surveyed reported having at least some difficulty paying for prescription drugs. PhRMA says that drugmakers give away $4 billion worth of prescription drugs annually through their assistance programs.

PPA is perhaps best known for its television ads featuring talk show host Montel Williams promoting "The Help Is Here Express," bright orange buses that stop in communities to provide assistance and information to people having a tough time paying for meds.

Since the PPA began, more than 5.5 million people across the country have signed up for one or more of the 475 participating programs, says PhRMA vice president, Ed Belkin. He notes that some drug company assistance programs have been around for more than 50 years, but many consumers do not know they exist or how to apply for the benefits.

"Clearly, in the wake of the economic downturn ... there are more and more people turning to the Partnership for Prescription Assistance, because these ... programs are a lifeline," Belkin says.

The PPA sponsors a toll-free number: 1 (888) 4-PPA-NOW (1-888-477-2669) and a Web site where people can check out programs and obtain applications. The programs each have different eligibility requirements.

Shopping for a Solution  Nearly 30 percent of Americans reported last year that they did not fill prescriptions because of cost, and 23 percent said they split pills or skipped doses to stretch out supplies, according to the Kaiser study.

But as retailers lower their prices, more people will be able to take the proper dosage of their meds, Wal-Mart spokesperson Christi Gallagher says.

She notes that the company's customers have saved more than $1 billion in drug costs since the chain lowered its generic drug prices three years ago. "Our customers are constantly telling us how much they appreciate the program," Gallagher says.

Other retailers have stepped up with free antibiotic deals, which provide common antibiotics at no cost to consumers regardless of insurance status or co-pays. The Midwest grocery chain Meijer launched its program in 2006 and filled a million prescriptions of its seven free antibiotics in the first year. Since then, Publix, Schnucks and other chains have started ongoing free antibiotic programs. This winter, even more retailers, including ShopRite, Wegmans and Royal Ahold (the parent company of the Giant and Stop & Shop chains), have jumped on board to offer select antibiotics gratis through March.

Though most health officials praise the efforts, some fret that providing cheap antibiotics may open the door to more antibiotic-resistant infections.

"While we appreciate the fact that many retailers are trying to assist customers," Hicks says, "there is some concern that this might lead to inappropriate antibiotic use." Although viral infections such as the common cold and flu don't respond to antibiotics, she says, tens of millions of antibiotics get prescribed for exactly those uses by doctors under pressure from patients—or patient's parents—to hand over scrips for them. Such overuse ups the resistance of bacterial infections to antibiotics, which has triggered potentially deadly superbugs such as MRSA (methicillin-resistant Staphylococcus aureus), or "staph".

The length of some discounted prescriptions also raises flags for Hicks, who works with the CDC's Get Smart program, which is designed to educate the public about the proper use of antibiotics.

A Spoonful of Samples  Millions of Americans have been able to skip a $4 pharmacy trip altogether and get free drugs straight from their doctors. Pharmaceutical companies distribute more than $16 billion in free drug samples annually to medical providers. PhRMA in its literature pegs this practice as "an important part of the health care safety net for low-income and uninsured patients," citing a 2003 study from the Journal of Family Practice. A study published in the AJPH last year, however, found that the bulk of free samples were distributed to patients who already had insurance coverage and were more likely to be financially able to purchase a prescription of the drug.

At the end of the day, says Stephanie Woolhandler, an associate professor of medicine at Harvard Medical School and co-author of the AJPH study, free samples and industry assistance programs are "mostly a way of diffusing much of the anger Americans feel about drug prices…. It's not an overall solution to this problem."

So what is the remedy? "Pharmaceutical companies need to change their business model," Matheis says. And, she says, "We need to have a system where everybody is covered, whether it's private insurance coverage or government-sponsored coverage."

In the meantime, The Help Is Here Express buses continue to crisscross the country to help staunch the growing need of people who are having a hard time paying for their prescriptions.

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