A few months ago several pharmaceutical companies that offer free drugs to low income seniors announced they would end that service.
The companies said those patients could find coverage through the new Medicare prescription drug benefit.
But some people don’t want to sign up for Medicare, claiming it’s too expensive.
And senior health officials—even those who are championing the Medicare benefit—are pleading with drug companies to continue to provide free drugs.
New Hampshire Public Radio’s Kerry Grens reports.
For years, thousands of people with low incomes in New Hampshire who qualify for Medicare have been receiving drugs through companies like Lilly, Takeda, and Novartis at no cost.
But come May fifteenth, that could stop.
Many are expected to sign up for the Medicare drug benefit and qualify for a low income subsidy, which will cost only a few dollars in co-pays.
But then are some forty five hundred in New Hampshire who won’t qualify for that subsidy.
Kellie Pollard, director of Medication Bridge at Sea Care Health Services in Exeter, says these patients are caught in a bind.
Pollard: We have people that are not paying for medication, getting it free through all the companies and now because they’re not eligible for the extra help portion are literally going from paying zero dollars to potentially four or five thousand dollars a year.
Incomes for this group fall between eighteen and twenty thousand dollars a year.
Pollard says that with co-pays, deductibles, and premiums, many of these patients can’t afford to join a Medicare plan.
Pollard: Most of what I’ve heard is: I can’t afford to do that, I’m not signing up for a plan, I’m won’t take my medicine.
That concern has been echoed across the country.
It prompted federal Health and Human Services Secretary Mike Leavitt to write a letter to the president of PHRMA—the drug companies’ trade association—to keep the free drugs coming.
And New Hampshire’s HHS Commissioner John Stephen followed suit.
Stephen: I would hope that the drug companies who have chosen to drop these seniors from the needed program of pharmacy assistance would seriously reconsider their actions. And there are real seniors that could be hurt by these acts.
Some companies—like Pfizer, Merck, and Bristol-Myers Squibb—will continue giving away drugs to people who don’t sign up for the Medicare benefit.
But there are also some drug makers—like AstraZeneca—that are reconsidering that policy.
AstraZeneca is one of the seven companies that sent letters to doctors and patients in New Hampshire informing them that assistance would stop for Medicare-eligible patients.
Spokesperson Andy Izquierda said the company dropped Medicare-eligible patients because the Medicare benefit would offer more comprehensive coverage, and because of some legal issues.
But HHS in Washington announced that pharmaceutical companies may offer prescription assistance programs—or PAPs—to patients who aren’t on the Medicare benefit without any legal ramifications.
Izquierda: It’s one of these fluid things in terms of evaluating our options. Come May 15th is there a possibility that other programs will be in place to help our Medicare Part D beneficiaries that are in our PAP? Absolutely.
But Bernie Cameron, director of New Hampshire Medication Bridge program, is preparing for the worst.
And she says New Hampshire will take a particularly hard blow because the state has no other safety net in place.
Cameron: All the other New England states have what they call SPAPs, which are state funded, state sponsored prescription assistance programs. So they use state money to help this low income population to help with the cost of their prescriptions. New Hampshire does not have a program like that and that’s why we depend so heavily on the pharmaceutical companies.
Cameron adds that she thinks it isn’t the responsibility of these private companies to take care of New Hampshire citizens’ medications.
Rather, the state should implement a drug assistance program.
But such help Cameron estimates carries a price tag of about twenty five million dollars.
She says the best chance of getting these drug costs covered is if the drug companies decide not to cut back their patient assistance programs.
But having a patchwork of free drugs can add a new dimension of complexity to a patient’s already complicated coverage.
Getting a Medicare benefit might ensure coverage of prescriptions that were no longer free, but it might mean disqualification for other drugs that continue to be given away.
SOQ
Thank You for your program on the Medicare D porgram and it's impact on the pharmaceutical patient assistance programs. As a psychiatric Nurse Practicitioner in a small private practice with one psychiatrist and two other nurse practioners, we are seeing a major impact on our patients and how we will be able to provide medication assistance for them. It is 95% negative. We have patients who have gotten the letters saying they will o longer be eligible for the assistance. One man called my office frantic and crying because he had received such a letter and had gone to the Medicare D counseling session, "plugged" in his medications to be matched with an insurance plan only to discover that he now would have approximately $4500.00 a year in medication costs! He is disabled and brings in less than 12,000 a year but because he has an IRA of 15,000 he has been trying to hold on to (he is not even 50 yet), he has too many "assests" to qualify for the medicaid/medicare low cost program.
The "legal" barriers mentioned in your article regarding maintaining some of the patient assistance program, for example for when the person enters the "doughnut" part of the program is "prohibited" by the way the legislation is written. It only benefits the pharmaceutical companies. It will take congressional action to change the language of the bill.
For us as clinicians the impact is that we are now in the positionof having to deal with multiple plans to secure prior authorization for either medications prescribed or dosages that need preauthorization. Sometimes that means one to four hours on the phone and/or paper work and then phone time for ourselves or our staff attemtpting to get the authorization. Sometimes we go through a lengthy repetitive process only to be denied. There is the potention for the number of hours needed to support this program to use over a month of clinican time and a month of staff time a year to try and help our patients. This is going to force us to limit the number of medicare patients that we can have in our practice. This is a significant loss for our area (North Conway) beccause there is such a lack of services for these individuals.
It is imperative that we and our patients have our voices heard by our legislators! Thanks for listening. Eleanor
It's ashame that the poor have to suffer. Thanks for reporting on a great article Kerry and congrats on your successful career.