Tools of the Trade

Helping Patients Avoid Hard Choices

There are ways for low-income groups to avoid paying top dollar for prescriptions. Here's one way physicians can educate consumers.

The rapid escalation in the price of prescription drugs presents some patients with a dire choice: filling a prescription or buying groceries. Instead of skimping on food or skipping the rent, patients who can't afford a copayment — or who lack a pharmacy benefit altogether (the plight of many Medicare beneficiaries) — may forgo filling the prescription you've just given them. They may be too embarrassed to ever let you know about their financial situation. Elderly patients are especially likely to be in these straits.

Drug expenditures have been increasing at an annual rate of about 15 percent — faster than other components of health care spending. They account for 8 percent of health care spending overall, but 10 percent of seniors' health care expenditures. According to a study by the University of Minnesota College of Pharmacy, annual spending by the elderly for prescription drugs increased by 116 percent between 1992 and 2000, rising from $559 to $1,205 per person. Meanwhile, overall health care spending per elderly patient increased by 59 percent.

Although it could be argued that increased drug expenditures have helped hold overall health care costs down, it nevertheless is true that people on fixed or low incomes are in a financial bind. Their predicament is likely to worsen, as more drugs (and more expensive drugs) become available. In 1992, the average older American received 19.6 prescriptions annually at an average cost of $28.50 each. By this year, it is expected that the elderly would receive 28.5 per person (average cost, $42.30), and by 2005, 34.4 per person — at an average cost of $55.54.

The opposing handout, which you may want to photocopy, provides information for budget-conscious patients. Information about assistance provided by states and pharmaceutical companies is readily available online. Remind patients who don't have a computer that many public libraries provide free Web access, along with assistance in using the computer and searching for information.

Prescribing a generic product instead of a branded one may help patients save money. The Generic Pharmaceutical Association claims that every 1 percent increase in generic drug use results in savings of $1.16 billion. Generic drugs account for more than 40 percent of prescriptions nationwide but less than 9 percent of drug expenditures.

If a branded product is essential, the manufacturer may be able to provide the drug free of charge. Member companies of the Pharmaceutical Research and Manufacturers of America (PhRMA) maintain an online directory. The alphabetical list of companies provides products available, instructions for making requests, and eligibility criteria.

How To Save Money on Prescriptions

Who doesn't want to save money on prescriptions? Look below for some suggestions. You can use the Internet to get telephone numbers and other details about assistance programs provided by states and pharmaceutical companies. If you don't have a computer, your public library should be able to help you, free of charge.

Generic drugs. If your doctor writes a prescription for a brand-name product, ask if it can be replaced by a generic drug. Generics can save up to 70 percent of the cost of branded prescriptions.

First-tier products. If you belong to a managed care organization (MCO), ask your doctor to prescribe a drug on the "first tier" of its formulary (list of preferred drugs). That drug is likely to be a generic product provided at no or very low cost. Drugs on the second and third tiers involve copayments that can be substantial, especially for products on the third tier.

Mail order pharmacies. Mail order pharmacies can provide substantial savings over the cost of prescriptions filled locally. Be sure to order only products that your doctor says you'll use for a long time. Otherwise, if your doctor changes or stops your prescription, you'll waste money. If you belong to an MCO, you already may have received information about ordering drugs by mail. Otherwise, you can go online to find mail-order pharmacies.

Pill splitting. It may be cheaper to split, say, 100-milligram tablets in two than to buy 50 milligram tablets. Ask your pharmacist about inexpensive pill-splitting devices, and whether it is safe to split a given product.

State assistance. Many states have pharmaceutical assistance programs for low-income people (especially the elderly). Programs are available in California, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, Vermont, and Wyoming. New or supplemental programs will take effect in 2001 in Florida, Kansas, Maine, Massachusetts, Nevada, and South Carolina, and Indiana has a new program whose operational date has not been determined. Details are available on the Internet at:

Indigent-patient programs. About 50 drug companies provide certain products free of charge to needy patients. Some companies make nearly all their outpatient products available, but others are more restrictive. In any case, your doctor must write a letter or submit a form to request free prescription drugs for you.

Details are available through an online directory at:

A printed copy of the Directory of Pharmaceutical Indigent Assistance may be obtained by contacting:

Pharmaceutical Research and Manufacturers of America
1100 15th Street N.W.
Washington, D.C. 20005
(202) 835-3400

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