Health Feature Articles
Medication Assistance Programs - Are They For You
Gail Carlson, MPH, Ph.D., Continuing Medical Education, School of Medicine, University of Missouri-Columbia
Prescription drugs are playing an increasingly
important role in health care. More Americans are using
drugs to manage chronic illnesses. Drug therapies are
also replacing surgery and other procedures that carry
greater risk. And, drugs can help us recover more
quickly when surgery is necessary. In general, drugs are
improving health outcomes and quality of life. However,
there is a price tag attached. Drugs are the fastest
growing segment of health care expenditures in this
country. As a result, some individuals go without the
drugs they need while others must choose between their
prescriptions and food, electricity or heating fuel.
There are lots of reasons why drugs are expensive.
Demand is high. As we get older, more of us are using
medications. The Food and Drug Administration has
implemented a faster drug approval process. This means
there are more new drugs available on the market. New
drugs cost more because of the research and development
involved. Drug firms were also given permission to
market directly to consumers. As a result, more is being
spent on marketing. In addition, consumers are
pressuring their health care providers to prescribe
these drugs no matter what the cost.
Data suggests that no matter what their age, people
without a drug benefit pay more for their medications.
There are no quick fixes to this problem. In order to
relieve some of the pressure on older adults, the
Federal government is considering adding a drug benefit
to Medicare. Missouri has also implemented its Missouri
Senior RX program. The program covers eligible seniors
with annual incomes up to $17,000 for a single person
and $23,000 for a married couple. Individuals must
enroll within 30 days of their 65th birthday or during
open enrollment periods. Go to
http://www.morx.mo.gov/index.htm or call
1-866-556-9316 for more information.
Individuals can help by becoming savvy consumers. If
you have a drug benefit as part of your insurance or
managed care plan, make sure to use it. Use generic
drugs when possible. Shop around for a pharmacy before
buying your medications. Think both in terms of price
and services you might need, like consultation with a
pharmacist or free delivery. Find out if mail order and
ordering in bulk could save you money. However, don't
use mail order firms or online services that will sell
you prescription drugs without your provider's
signature. Your first concern is your health. Don't risk
it by taking prescription drugs without your provider's
knowledge. Finally, talk to your provider. Let him/her
know that you have to pay for prescriptions out of your
own pocket. Your provider may recommend a generic drug
or substitute a less expensive medication that is just
as effective. Your health care provider also may be able
to help you apply for a medication assistance program.
Most drug manufacturers offer medication assistance.
Almost all programs require participants to have limited
income, limited or no prescription insurance coverage,
and limited or no public assistance for medications
(e.g., assistance from Medicaid, Department of Veterans
Affairs, etc). The most common form of assistance is the
provision of free prescription drugs. Medications are
given to qualified individuals for a limited period of
time ranging from three months to a year. Some companies
act more like a claims office helping individuals
determine the extent of their drug coverage, identifying
billing problems and resolving claim denials. A few
companies offer payment limitation programs. When drugs
are expensive or must be taken over a long period of
time, the company determines a cost limit that must be
paid by the patient; the company then pays anything over
that amount.
Each company operates its own program and eligibility
criteria vary from program to program. Furthermore, not
all drugs manufactured by the company may be included in
the program. Some programs have a pre-enrollment process
that can be started by telephone. Some require a health
care provider, or a patient advocate such as a
pharmacist, social worker, or nurse, to do the
pre-enrollment, or write for the application. Some have
application forms the size of a small booklet, others
have a one-page form and yet others simply ask for a
letter of need on the physician's letterhead. Some
require that an eligibility review be done every three
months, while others require this review annually. Some
companies send medications to the physician's office.
Some send them directly to the patient's home, while
others use a drug card that can be taken to a
participating pharmacy. Also, some programs require
patients to pay a nominal fee or shipment charge once
the patient has been accepted into the program.
If you want more information about medication
assistance programs ask your health care provider or
pharmacist; or contact the company that makes the drugs
you use. Your pharmacist should be able to help you find
names and addresses. Pharmaceutical Research and
Manufacturers of America (PhRMA) has developed a
directory of medication assistance programs. All
companies listed are members of PhRMA. The directory is
on the web at
http://www.phrma.org/, or call (800) 762-4636 and
ask for a copy of the 2002 Directory of Prescription
Drug Patient Assistance Programs. Other Internet sites
for information about medication assistance programs are
http://www.medicare.gov/ and
http://www.needymeds.com.
Participating in these programs requires a team
effort. Physicians must be involved in the application
process. At a minimum they must agree to participate in
the program and sign the application. Most individuals
also find that they need assistance from their provider
or a patient advocate to complete the forms. Some
providers choose not to get involved in these programs.
They don't consider them a stable source of medications
for their patients and there is added staff time needed
to complete the applications and manage the distribution
of the medications. Some individuals also find
participation frustrating. They may be accepted into the
program and then find that when they reapply, at three
months or a year, they are no longer eligible. In spite
of these concerns, medication assistance programs are a
potential resource for those who are least able to pay
for their medications.
References
1) Copleand, Craig. (April 1999) EBRI Issue Brief -
Prescription Drug Costs Up Sharply-But Still Small
Overall. Employee Benefit Research Institute (EBRI).
2) U.S. Department of Health and Human Services. (April
2000) Prescription Drug Coverage Spending, Utilization,
and Prices.
3) Health Pages. (1998) How to Save on Prescription
Drugs.
http://www.thehealthpages.com/
4) Chisholm, Marie A., Bess O. Reinhardt, Leslie J.
Vollenweider, Bridgett D. Kendrick, and Joseph T. Dipiro.
(2000). Medication Assistance Reports: Medication
Assistance Programs For Uninsured and Indigent Patients.
Am J Health-Syst Pharm 57(12): 1131-1136.
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Last Updated 05/05/2009
