Two main types of assistance are available from pharmaceutical companies. Several companies offer programs that allow consumers to take a discount drug card to the pharmacy to get a discount off of the price of prescription drugs. And most major pharmaceutical companies offer PAPs, which give free or low-cost medicines to people in need.
Because these programs typically target people without health insurance and people who don't qualify for government-funded programs, some are expected to change over the coming year with the launch of the Medicare Prescription Drug Benefit. For example, as of June 2005, GlaxoSmithKline (GSK) had about 200,000 members in its Orange Card program, according to Patty Seif, a spokeswoman for GSK. The card offers 20 percent to 40 percent off the usual price of the company's drugs, and is open to older people who are without health insurance and who have an annual income not exceeding $30,000 to $40,000 for a couple. As a program for Medicare enrollees, the Orange Card program's final year will be 2006, Seif says.
The Together Rx Card, launched by 10 pharmaceutical companies, provides financial help on prescription drugs until the Medicare drug benefit starts. The card gives U.S. residents who don't have drug coverage and who are within certain income levels average savings of 25 percent to 40 percent on their prescription drugs. The final day to use a Together Rx Card is Dec. 31, 2005.
Maggie Kohn, a spokeswoman for the drug manufacturer Merck, says that unlike many other programs, Merck's discount program offers discounts of 15 percent to 40 percent on many of the company's medicines to uninsured patients, regardless of age or income. About 15,000 people signed up for the program within the first few weeks that it began in April 2005, Kohn says.
Merck's PAP supplied 700,000 patients with 6.7 million prescriptions valued at $490 million in 2004, Kohn says. Patients may qualify if they have a household income below $19,140 for individuals, $25,660 for couples, and $38,700 for a family of four. "We do sometimes make exceptions for patients whose incomes exceed these amounts in special circumstances like if they are taking a number of medicines," Kohn says.
The Partnership for Prescription Assistance (PPA), which was launched in April 2005, is an industry initiative that's helping patients find assistance programs faster. "With one call," Seif says, "patients are directed to programs that could be most helpful." The PPA provides a single point of access to more than 275 public and private PAPs, including more than 150 programs offered by drug companies. The PPA also will show people how to contact Medicare and other government programs.
"We know that medicines, when taken as prescribed, improve lives and decrease overall health care spending," Seif says. "But for people who can't pay for them, any price is too high. That's why GSK and the pharmaceutical industry support programs that make our programs accessible." In 2004, GSK provided 372.5 million dollars' worth of free medicine.
Every company has its own eligibility criteria for PAPs, and, in most cases, U.S. citizenship and some proof of income, such as tax records or a record of social security benefits, are required.
In the April 1, 2005, issue of the American Journal of Health-System Pharmacy, researchers looked at clinics' use and assessment of PAPs. They concluded that PAPs help fill a major gap in health insurance coverage, but that consistent eligibility and application procedures are needed. The researchers identified the program's responses and changes to the Medicare drug benefit as a potential area of study.
They also reported that the benefits of helping patients get needed medication came with additional costs of clinic time spent dealing with them. Lisa McTavish, M.D., a family physician with the Arnett Clinic in Rossville, Ind., says her small office couldn't afford to help patients navigate PAPs until 2003, when a volunteer patient advocate named Susie Gray came on board. McTavish says it's been worth it. In the first six months of 2005, Gray helped patients save about $63,000 through PAPs.
"We have found that hospital and emergency admissions have decreased for most patients in the program," McTavish says. "That's because the patients are taking the medications they need and they aren't as stressed about how they will pay for them."
Gray, who works as a patient advocate two days a week, says she started with 13 patients in 2003 and now works with about 130. "I start by finding out which company makes the particular medication, then I get the forms and work with patients to fill them out," Gray says. "It takes about four to eight weeks to hear back about whether the patient is accepted." Gray also keeps track of medication orders and re-orders.
Patients who don't have access to someone like Gray can initiate the PAP process on their own by printing forms off the Internet or by calling pharmaceutical companies directly to request forms. Patients should fill out as much as possible, and then take the form to their doctor's office. PAP forms require a doctor's signature.
"At first, many of the patients who come to see me say they don't want the medication because they can't afford it, so I help them realize what their options are," says Gray, who decided to work as a patient advocate after helping her husband through three heart attacks. "I feel good about what I'm doing," Gray says. "A prescription doesn't do the patients any good if they can't get the medicine."