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Patients Seek Financial Aid to Buy Medicine
By Vanessa Fuhrmans,
The Wall Street Journal
October 21, 2008
Layoffs drive rise in interest in programs aimed at poor; help navigating the choices.
As the slowing economy swells the ranks of the unemployed -- and uninsured -- more people are getting help from prescription-drug assistance programs normally aimed at providing medications to the poorest Americans.
Drug-assistance programs, long sponsored by pharmaceutical manufacturers, provide consumers with billions of dollars a year in free or low-cost drugs. To qualify, patients must meet strict financial requirements. But as the economy weakens, a growing number of people are getting approved for programs to help them pay for high-price drugs. For example, a year's supply of Advair, a popular asthma drug, can cost around $2,500 a year, while Plavix, a blood thinner, can run more than $1,800 a year.
Making Drugs Affordable
Drug companies say enrollments in their patient-assistance programs have risen.
• Various Web sites help guide patients to applicable programs.
• To get approved, patients must have low income, but they shouldn't assume they won't qualify.
• The application process is lengthy. Local organizations can help fill out the paperwork.
"These programs have always been designed to be a safety net, but more and more people are falling into it," says Ken Johnson, spokesman for the Pharmaceutical Research and Manufacturers of America, or PhRMA, which represents big drug companies. The group says in recent months that its Partnership for Prescription Assistance service has helped enroll more than 100,000 patients a month into private and public programs -- an 11% increase from earlier this year. In states such as New York and Florida, the number of people approved rose more than 20% in the third quarter, the group says.
Hazel O'Day, 47 years old, says that until several months ago, she never imagined she would need to find free medications. For 20 years, she and her husband owned a busy party-supply rental company in Sarasota, Fla. "We had property; I even had a housekeeper," she says. But the business became a casualty of the state's slumping economy, and the couple had to discontinue their health insurance.
Ms. O'Day, who moved to Campbell, N.Y., to live with her daughter after her husband died, suffers from severe arthritis, thyroid disease and depression. She says she began skipping some doses of her medications to stretch them out. On a friend's advice, she contacted Health Ministry of the Southern Tier, a health-services center that helped her win approval from Pfizer Inc. to receive free supplies of her anti-depressant, Zoloft, which normally retails for more than $1,200 a year, and Synthroid, which can cost about $200 a year, from Abbott Laboratories.
Local health-services groups and clinics that help with applying to assistance programs say that over the past half year they have noticed a shift in the kind of people seeking assistance. "We saw a lot of laborers, construction industry and real-estate people at the beginning of the year," says Kimberly Chmielewski, executive director of the Community Pharmacy of Sarasota in Florida, which helps patients secure free or low-cost drugs. "Now it's more professionals, more people who've been laid off by large employers and who've just had to give up their health benefits."
AstraZeneca PLC of the U.K., which markets such medications as Nexium for acid reflux and Crestor, a cholesterol drug, says patient requests have increased across its assistance programs in the U.S. This includes insured people who can't afford their drug copayments and Medicare beneficiaries who run up against drug-coverage gaps. Last year, the company says it enrolled 15,000 seniors in assistance programs; that number already reached 21,000 by the end of September.
Bristol-Myers Squibb Co., whose products include Abilify, for treating bipolar disorder, says it accepted 3,000 new patients into drug-assistance programs in September, a 20% increase from the monthly rate this year through August. The company expects to enroll a similar number in October.
A number of drug makers say they are prepared to expand their programs in response to the growing influx of patients. "We believe in the free-market health-care system, and that system is at risk if more and more people fall through the cracks," says PhRMA's Mr. Johnson. The group's 35 member companies have provided $13 billion in free medications since 2005, he says.
Still, applying to drug manufacturers' patient-assistance programs can be daunting. Many companies have different programs for different drugs, and each program often has its own set of rules. In addition to the application, programs often require tax statements or other proof of income, a prescription and other information from a doctor, and sometimes a letter that Medicaid or a private insurer has refused to cover the expense.
How to Apply
Application forms for many programs are available from the drug companies or from patient-advocate Web sites, including NeedyMeds.org, as well as from pparx.org, the site of PhRMA's Partnership for Prescription Assistance. The sites generally guide patients to specific programs, and some may offer references to local community groups that help people fill out the applications.
Other online services ask for an administration fee of $5 to $10 to fill out applications, which is refunded if the patient is rejected. But patient advocates warn consumers to steer away from sites that charge much more than that. Despite the lengthy paperwork, advocates say most patients can tackle the application process on their own.
Once a patient is approved, medicines can take from two days to a month to arrive and are usually sent to the patient's doctor or pharmacy. Many companies also require patients to apply for approval every three to six months. They may not provide assistance for all drugs or dosages.
Most states sponsor a handful of programs that also help low-income people who aren't poor enough to qualify for Medicaid. These include specific programs for AIDS patients, children or the elderly. The patient-advocate Web sites provide the quickest overview of what's available state-by-state, as well as from foundations that help patients with certain diseases, such as the Chronic Disease Fund and American Kidney Fund.
Many drug-company assistance programs were launched decades ago, partly for public-relations efforts. Today they also serve as a marketing tool, particularly as companies struggle to come out with new products and consumers have trouble paying for them. Indeed, the number of total U.S. prescriptions filled was down in the second quarter, the first decline since 1997, according to market researcher IMS Health. By providing drugs free while patients have no coverage or are down on their luck, companies hope consumers continue on those brands once they have insurance or a better financial footing.
Losing a Job
Barbara Barndt of Venice, Fla., who has a rare form of leukemia, lost her office-manager job and health coverage when the building company she worked for went out of business. Earlier this month, the 62-year-old turned to the Community Pharmacy, which helped her fill out the paperwork for a Bristol-Myers Squibb program. Ms. Barndt is waiting to hear if she qualifies to receive free supplies of the cancer-fighting pill, Droxia, which can cost more than $1,100 a year, depending on the dose. She also is purchasing a generic medication, allopurinol, to help treat some side effects of her cancer, with the help of a discount card.
"I've worked all of my life," says Ms. Barndt. "Never did I think that at this point I'd be jobless and lose all of my health care."
Most patient-assistance programs require enrollees to have incomes at or below 200% of the federal poverty level, or about $42,000 for a family of four. But patient advocates say consumers shouldn't assume they don't qualify.
AstraZeneca, for instance, raised its annual income limits two years ago to $30,000 for individuals and $60,000 for families. Richard Sagall, cofounder of NeedyMeds.org, says some programs allow incomes as high as 400% of the poverty level.
Income Levels
Other company programs that are aimed at Medicare drug-plan members or at helping with drug copayments are more concerned with the percentage of income a person is spending on all of their medications. "I always encourage people to call the programs because it's often speaking one-on-one that they may be able to help them," Dr. Sagall says. Advocates also encourage patients to write a personal letter in applying for programs, especially if they don't have a tax return, or if the latest return doesn't reflect a recent job layoff or change in circumstances.
More enrollees in patient-assistance programs are like Lauren Brill, a self-employed marketing consultant in Chicago. When Ms. Brill turned 50 this year, she qualified to purchase a health plan through AARP. But the plan doesn't cover her pre-existing condition of psoriatic arthritis.
Ms. Brill is enrolled in an Abbott Laboratories patient-assistance program to help pay for her Humira arthritis medication, which she says enables her to have an active life that includes bike riding and walking half-marathons. On her own, the drug would likely cost more than $19,000 a year.
"It really pays to ask," Ms. Brill says. "Now I can worry about my mortgage and other things, but not about this."
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