Drug firms' freebies don't fill Medicare gap

Newhouse News ^ | 12/15/2006 | Bill Walsh

[Incorrigible]

Drug firms' freebies don't fill Medicare gap

BY BILL WALSH

WASHINGTON -- As a pitchman for the drug industry, TV personality Montel Williams touts the "more than $5 billion" in free medicines given away by manufacturers this year.

"You need help?" he asks in an industry-sponsored ad. "Just call."

The ad should carry a giant asterisk, however, as most of the drug companies' patient assistance programs do.

With millions of Americans falling into Medicare's "doughnut hole" -- the coverage gap in the middle of the program's drug coverage -- many seniors and disabled people have turned to manufacturers' much-trumpeted giveaway programs for help.

Williams' assurances notwithstanding, help is often more than a phone call away -- if it is available at all. Drug companies say their efforts are often hampered by government regulations and legal issues.

Dozens of companies don't offer assistance to people if they are enrolled in the Medicare drug benefit, even if their coverage has fallen into the "doughnut hole."

The help available from other companies comes with a snowstorm of asterisks. Some drugs are covered, others aren't. Some charge patients $25 per prescription. Others require patients to spend as much as $600 out of pocket to qualify. Others will help only people they have helped in the past.

And it's not easy to find out what the exceptions are. Some companies list eligibility requirements on their Internet Web sites. Others don't.

About 23 million seniors and disabled people are enrolled in Medicare's drug subsidy program, which kicked off Jan. 1. But coverage is limited. After their drug costs hit $2,250 in a year, enrollees pay the full tab until costs reach $5,100 and the coverage resumes. That is the "doughnut hole."

The drug industry, through its trade group PhRMA, says it has helped 3 million Americans through 475 patient assistance programs, including 180 run by the drug companies. But the generosity doesn't always extend to people who have signed up for the Medicare drug benefit.

Last year, the inspector general for the Department of Health and Human Services issued a warning that companies attempting to give away their products to people in Medicare's "doughnut hole" could run afoul of federal anti-kickback laws. The concern was that companies would use giveaways to steer patients to their products. "Subsidies present all of the usual risks of fraud and abuse," the November 2005 advisory said.

"All we wanted to do was provide help to people struggling to pay their bills and instead we were confronted with legal hurdles," said Ken Johnson, a spokesman for the drug industry in Washington.

Bristol Myer Squibb is among those that do not extend patient assistance to people in the "doughnut hole." Spokeswoman Laura Hortas said it makes exceptions for people with "life-threatening conditions" and facing "serious financial hardships."

Hortas said the company has held off offering free or low-cost drugs to everyone in Medicare's drug benefit program as it waits for an advisory opinion from the inspector general about a new multi-company consortium.

"We're working toward one," she said.

Some patient advocates say companies are using the inspector general's advisory as an excuse. The inspector general has issued several more advisories explaining how giveaway programs could be structured to avoid controversy. The easiest way is for companies to make their drugs available to a charity, which could get them into the hands of patients in need. Few have followed that advice, preferring to keep control over their drug distribution chains.

"We are trying to counter the message that PhRMA is giving out that patient assistance programs have to end. They don't," said Janet Walton of Rx Assist, an Internet-based clearinghouse for drug information. "It is absolutely possible to work within the guidelines the inspector general finds acceptable."

GlaxoSmithKline will begin offering its GSK Access program to people on the Medicare drug benefit program next year. A spokeswoman said that even before the Medicare benefit kicked in, the company proposed giving away free drugs to people who ultimately were in the "doughnut hole."

"Then the inspector general's ruling came out saying it would be an anti-trust violation," Patty Seif said. "We decided to have an interim program until we worked things out with the federal government."

Glaxo's interim program was open only to people who had been in the company's patient assistance program before. That put the company's cutting-edge HIV medicines off limits to many people whose Medicare coverage lapsed.

"This is the first time we've had to say, `No, we can't get your medicines anymore,"' said Martha Zimmerman, a clinical social worker at Duke University Medical Center.

Glaxo's new program, which starts Jan. 1, will make all of its drugs available free to people in the "doughnut hole." The asterisk is that patients have to spend $600 out of their own pockets first.

"That does us no good," Zimmerman said. "Our patients don't have $600."

Other drug companies have other guidelines. Schering-Plough requires patients to show their drug costs exceed 3 percent of household income. Eli Lilly has limited its giveaway program to three drugs. And it's not entirely a giveaway. Patients pay $25 for a 30-day supply of each.

An Eli Lilly spokesman said the three drugs -- Zyprexa, Forteo and Humatrope -- represent about 70 percent of those requested in the company's patient assistance program. But patient advocates wonder why companies can't make all their drugs available.

"If you can do it for one, why not all of them?" asked Walton of Rx Assist.

Asked why Eli Lilly didn't take the inspector general's advice and allow a third-party charity to dispense its drugs, spokesman Ed Sagebiel said, "We looked at that option and this is the option we chose."

Finding coverage in the "doughnut hole" has become a more pressing issue as the year winds down and more people run out of coverage. Those who use high-cost drugs to treat such things as HIV and cancer fell into the coverage gap months ago.

Some have avoided the gap by enrolling in special Medicare health insurance plans that provide coverage during the interim. In 2007, according to the liberal health advocacy group Families USA, the price for those plans will skyrocket. In the upper Midwest, the group said in a November report, prices for "doughnut hole" coverage will go up an average of 185 percent to $110 per month.

And the coverage can be spotty. The group's report said that in 13 states -- Alaska, Hawaii, Florida, Michigan, New York, North Carolina and all of New England -- the "doughnut hole" coverage won't cover most of the most commonly prescribed drugs for seniors.

"If they don't offer most of the prescribed drugs out there, it doesn't do most seniors very much good," said Dave Lemmon, communications director for Families USA. "It means that when they get to the doughnut hole, they were right back where they were. They have no coverage."

Dec. 15, 2006
 
(Bill Walsh can be contacted at bill.walsh@newhouse.com.)

Not for commercial use.  For educational and discussion purposes only.

[Incorrigible]

Drug companies are not charities.  It's government intervention in the market that is going to drive us to national healthcare and Hillary is just fine with that.

[rellimpank]

--yeah--thanks largely to the miracles of modern chemistry (and a bunch of disproportionally Jewish medical researchers) life expectancy has improved so much over the last seventy years that every senior center is full of greedy geezors/geezeratrices complaining about the price of the stuff that's keeping them alive--
--let's put these eeevvilll drug companies out of business with taxes, congressional "investigations", etc.,--

[Incorrigible]

$180 million for the retiring Pfizer CEO? Peanuts. The government will get $90 million!

[Incorrigible]

Related thread:

Drugmakers brace for fight with Democrats over prices

 

[Belasarius]

DU has started up a thread on you. Apparently they don't understand your brand of sarcasm ...

I get it...somehow what you wrote is entirely out of their frame of reference.... wierd...

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=364x2971487

[rellimpank]

---hilarious--I guess I better change my tagline to something on the order of "sarcasm intended"---

[therut]

Well let's see these persons had no coverage before Medicare drug plan tax payer freebies and how long did it take them to punch the gift horse in the mouth cause it is not completely free enough. Well I say lets just ditch the plan since they are whinning so much. Please this plan was writtien to favor the poor that are not on Medicaid not to pay for richer old peoples medicine. We as a country can not pay for everyone on Medicare for all their medications. We can not afford what we are doing now. We are a stupid people.

[Incorrigible]

PJ,

Check out the link in #5!

[rellimpank]

--the intellectual depth on DU amazes me-----

[rellimpank]

---reading it again , I do see that they finally had a poster (#21) smart enough to get sarcasm---

[iowamark]

NeedyMeds.com is an excellent site covering Patient Assistance Programs.

Recommend this site to anyone having trouble with prescription drug costs. It has links to every program. You can search by a drug's generic or brand name.