A Break for Those With High-Cost Drugs

Far more than ever, before I prescribe a medication, I ask patients if they have the ability to pay for what I hope to make available to them. I do so because I know that some will simply not fill the prescription due to cost, others will fill it and then make an effort to stretch out its use, and some will simply do without other staples in order to take what has been prescribed.

Although the winds of change are rife with plans to provide assistance, precious little is currently available and likely what will be available, although helpful, will still not meet everyone's needs.

There are at least four groups of patients for whom medication costs are a significant barrier to getting well: the elderly on Medicare, those with no insurance, those with insurance but a high deductible, and those with insurance with higher co-pay amounts for certain prescription medications. The first three groups are at the greatest risk.

At the same time, we are exposed to ever more direct advertising by pharmaceutical firms seeming to imply that what is newest is best, thereby stimulating demand for the latest and supposedly greatest while implying that those of us in the medical profession writing for generics or older meds are giving short shrift to our patients in an effort to balance someone's budget.

For many years, research-based pharmaceutical companies (the ones that develop new medications) have had what are called patient assistance programs. These are company-specific and exist in order to make first-line medications available to qualified applicants at a reduced cost or in many cases, free of charge.

In 2002, research-based pharmaceutical companies helped 5.5 million patients fill over 14 million prescriptions. This is the up side. The down side is that until now, a patient, relative or family friend, or patient advocate had to go the web site of the manufacturer of each desired medication (most people do not know the name of the company that manufactures their medications), fill out an extensive series of questions that are appropriately personal and address income and current medical coverage, and then submit this information either by mail or online to learn if the patient is qualified for that particular company's program.

Partnership for Prescription Assistance is a combined effort on behalf of pharmaceutical companies representing 250 patient assistance programs covering more than 1200 prescription medications. To apply now, one need only go to www.pparx.org and type in the name of the desired medication.

Following that, the web site will see if that medication is available and if so, direct you to a series of forms that are fairly extensive and may take awhile to complete. You will need to have very complete information available on your financial status, as the programs are targeted to help those with the greatest need and least ability to pay. The advantage is that you only need to supply this information once and it will be automatically applied to the specific manufacturer with your medication. If you qualify, you will need approval from your doctor and then determine where it is most appropriate to have the medications sent.

Access to this program requires the presence of a computer with Internet access. If you do not have one available at home or work, the program brochure suggests a trip to your local library or a variety of other locations with computer availability.

The Wisconsin Academy of Family Physicians is one of the key sponsors and can be reached by phone at 800-272-9237 to request a brochure with information and background on the program. Even though the website is very user-friendly, I suggest that you get a friend with some computer experience to help for the first go-round.

While this is far from as simple as taking a prescription from your doctor to the pharmacy, this is a significant step that will for many offer an alternative to high out-of-pocket costs or just simply going without.

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