Drug makers give prescription drugs to low-income people
March 22, 1999
BY BOAZ HERZOG
Free Press Business Writer
For years, Charlotte Latiker was confronted with a
wrenching decision: Do I eat or pay for my
medication? Most of the time, she chose medication.
"It was terrible," she said. "I was in constant pain."
Plagued by rheumatoid arthritis -- a debilitating,
chronic disease that causes inflammation, pain and
swelling of the joints -- Latiker, a 52-year-old
Romulus resident, was forced to quit her job as a
therapist's assistant 15 years ago.
She lived on paltry workers compensation and later
on disability insurance checks, often spending almost
half her income on prescription drugs.
Then four years ago, a pharmacist told her she could
receive medication free.
She discovered that most major pharmaceutical
companies have patient assistance programs that
provide free prescriptions -- including lifestyle drugs
such as Pfizer's Viagra for impotence and Merck's
Propecia for hair loss -- to low-income people who
don't have private insurance and don't qualify for
government insurance programs.
But many low-income people are unaware they
could be receiving prescription drugs for free,
advocates for the poor say.
The number of prescriptions dispensed in the United
States grew 8 percent last year to 2.6 billion,
according to IMS Health, a Plymouth Meeting,
Pa., health research company. That equates to an
annual average of nearly 10 prescriptions per
person.
But many people such as Latiker can't afford pricey
pills.
Almost one in seven Americans -- 35.6 million --
lives in poverty. And the cost of prescription drugs is
rising. Prices climbed 3.9 percent during the last
three months of 1998 compared with the same
period a year earlier, far outdistancing the overall
1.5-percent U.S. inflation rate, according to IMS
Health.
Pharmaceutical companies organized their drug
assistance programs after Congress backed off
threats to regulate drug prices in 1992. Many drug
makers now offer most of their products free to
people who meet guidelines.
But some doctors shy away from the programs
because of the paperwork, and some in need of
prescriptions are too embarrassed to seek help.
Nevertheless, the number of pharmaceutical
companies offering free prescriptions is increasing.
Forty-eight drug programs were listed in the 1998
directory compiled by the Pharmaceutical
Research and Manufacturers of America, a
Washington lobby that represents about 90 percent
of the industry.
At least three more companies will be included in the
1999 list, a spokesman said.
About 1.4 million Americans received free
prescriptions from the drug makers offering patient
assistance programs last year.
Hundreds of thousands of Michiganders also
accepted free and low-cost drugs through several
community and state programs. The State of
Michigan spent an estimated $500 million last year
on prescription drugs for its 1.1 million enrollees in
Medicaid, a federal-state health insurance program
for the needy and disabled.
"There are all sorts of services out there for people,
but they don't know what they are. It's pathetic,"
said Carolyn George, chief executive officer of
World Medical Relief. The Detroit agency gave
away $1.7 million worth of drugs to about 1,500
people in Wayne, Oakland and Macomb counties
last year.
How programs work
"I dread every time I have to do this," said Latiker,
who fills out application forms every three months
for two medications -- Imuran for arthritis and
Capocide for hypertension -- she gets free from
pharmaceutical companies.
She would normally spend about $180 a month for
the two drugs. But through the drug makers she pays
$13 a month to her pharmacist for the cost of
dispensing the medication.
Latiker and her doctor each must fill out different
portions of the application forms, which require data
on income and expenses. The forms are then sent to
the drug companies, which either relay the requested
medication directly to the doctor or send the patient
a card to use at a pharmacy.
Latiker knows how the system works, but she said it
can be bewildering and disheartening for first-time
applicants. The biggest problem, she said, was
getting doctors to cooperate.
"It was a big struggle at first. I've been belittled. I've
never been so put down in my life. I went through a
lot of depression," she said.
"The doctors don't want to be bothered. They'll
write the prescription and that's it. I had one doctor
tell me to discontinue the medication because he
didn't want to sign me up to get it. I had one
pharmacist say that he'd rather that I go somewhere
else."
Latiker now spends about $70 to $80 a month --
about 10 percent of her monthly disability income --
out-of-pocket on four other drugs she takes for
arthritis and pain. She said she's reluctant to apply to
receive them free through the manufacturer.
"I'm kind of embarrassed to keep asking the
doctor," she said.
At the Thomas Judd Care Center in Traverse
City, Mary Dillinger, an HIV clinical nurse specialist
and case manager, sees people with mind-sets
similar to Latiker's.
"Often when we as health care providers give
someone a prescription, we don't ask them if they
are going to be able to purchase it," she said. "We've
assumed they've taken it. The problem is that they
don't tell you they can't afford it. Many are proud.
They just quietly leave and never fill the
prescription."
As a result, Dillinger said, she spends much of her
time assessing patients' needs and trying to sift her
way through the free-drug application forms.
"Some of the drug companies' processes are very
streamlined and easy to do without a lot of hassle,
and others require your first-born child," she said.
The drug companies say that help is available for
confused applicants.
"If a doctor calls us and says the paperwork is too
complicated, we have someone who will walk them
through it," said Ramona DuBose, a spokeswoman
for Glaxo Wellcome. Last year the North Carolina
company gave away $25 million in free drugs
through its patient assistance program, helping about
20,000 people a month, she said.
Spreading the word
The drug makers don't publicize the free drug
programs to the people who would benefit from
them. Instead, they rely on patient advocates --
doctors, nurses, pharmacists and social workers --
to spread the word, said Mark Grayson, spokesman
for the Pharmaceutical Research and Manufacturers
of America,
"Doctors know about it, and social workers know
about it," he said. "There's a lot of places where this
information exists."
Some doctors disagree.
Joseph Weiss, a rheumatologist with a private
practice in Livonia, said he had never heard of the
free drug programs until one of his patients, Latiker,
asked him to fill out some forms.
"She had to educate me," Weiss said.
He said pharmaceutical sales representatives visit
him at least once a week and often give him free
drug samples. But Weiss doesn't rely on the samples
to treat his patients.
"Giving sample after sample is not a good way of
doing things, because most run out," he said.
The sales representatives never discuss patient
assistance programs, he said.
"No one's ever said, 'Oh, and by the way, there's
this program we have that gives free drugs to people
who can't afford them.' Somebody might have
mentioned it in passing once," Weiss said.
Other doctors might know about the programs, but
they are used sparingly, said David Fox, spokesman
for the Michigan State Medical Society.
"They either give out free samples, or every once in
a while they'll use the programs, but it's not anything
that has widespread use," he said.
Help in Detroit
Some of the free drug samples that doctors receive
eventually make their way to World Medical Relief
on Detroit's east side.
On the second floor of the nine-story brick building,
nine grocery carts sit filled with small packages of
drug samples.
Volunteers use dental picks to pop out the pills into
plastic bags, which litter tables and shelves in the
small warehouse. Pharmacists then count out the
required prescription and send it down to patients
such as Detroiter Charles Hughes, who waits on the
first floor.
Hughes said he's been coming to World Medical
Relief for the last year to receive two prescriptions
for his arthritis, which makes it difficult for him to sit
or walk.
"It does relieve the pain some," he said.
He pays the agency a $2-per-prescription handling
fee. The two drugs normally would cost about $160
a month, said Hughes, who lives on a $760 monthly
Social Security check.
"I don't have money to get it at the drugstore," he
said. "I can't afford that. I can take aspirin, but that
doesn't do any good."
World Medical Relief, a United Way agency, gets
about 80 percent of the drugs it dispenses from
metro Detroit doctors donating unused samples. The
remaining medication is bought using funding from
United Way and othercharitable foundations.
"What if all this were wasted and gone to the
dump?" asked Pat Roos, one of the agency's two
paid pharmacists, shaking her head. "I believe in this
program. People are being helped."
Contact Boaz Herzog at herzog@freepress.com
or at 1-313-222-6731.
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