Drug assistance from drug makers.

Hanson, Karmen

Although money problems are limiting the development of new, large scale, state pharmaceutical assistance programs, some legislators are finding out what can be done at little or no state expense.

Prescription drug costs run into the billions, but legislators are finding ways to help low income and elderly people by leveraging free drugs from pharmaceutical manufacturers.

Most major drug companies have their own free drug programs or patient assistance programs (PAPs) to help low income seniors. Some have been operating since the 1950s, when information about the programs was funneled through doctors. Now there are hundreds of them. They are publicized online and in magazines, and people can readily find applications at doctors' offices.

The 48-member companies of the Pharmaceutical Research and Manufacturers of America (PhRMA) provided more than $2.3 billion in mostly brand name medicines through these programs last year. Each program differs by manufacturer, but usually requires that patients meet strict qualifications, such as chronic conditions and incomes below $16,000 a year. PhRMA's booklet listing the programs is widely distributed and readily available online.

LEGISLATORS GET INVOLVED

Lawmakers are turning to these free drug programs to help their constituents at a time when tight state budgets are limiting expansion of subsidized or discount pharmaceutical programs run by about 30 states.

Some states are distributing information about the free programs, staffing offices and call centers to answer questions, and often assisting seniors with the application process. Some states have worked to create a single application process aimed at simplifying the maze of more than 130 different manufacturers' programs.

The programs cost money, but the benefits far outstrip the investment. Alabama will spend $1.5 million this year and $1.2 million next year to help elderly citizens apply for the free drugs. Run through the Department of Senior Services, the Alabama SenioRx program has so far saved state residents more than $10 million.

"We have had tremendous success partnering with the pharmaceutical industry to provide the latest medicines, particularly for our elderly," says Alabama Senator Lowell Barron, who is a pharmacist.

In Hawaii, there is a new public-private effort to get Out information. The Prescription Care Hawaii program is funded in part by The Harry and Jeanette Weinberg Foundation. As many as 20,000 seniors are expected to benefit from the program in the first six months of operation.

Maryland's Medbank is the country's largest state-funded prescription assistance program using free drugs from manufacturers. The state puts in $2 million and administers the program. It also provides interim prescriptions until applicants are accepted for free assistance. Medbank serves 20,000 patients, providing $13.5 million in pharmaceutical products through a highly efficient computer processing program that links the application forms. "It's all done on the Internet through a secure server and protects the patient's privacy," says Chief Executive Officer Robert McEwan.

Program officials act as mentors to new patient assistance clearinghouses across the country and also sell their software at affordable prices to other groups interested in starting similar programs.

Florida Speaker Johnnie Byrd is backing a program, Sunshine for Seniors, that would create a single application process for low-income elderly citizens for the various pharmaceutical manufacturer programs. It would supplement the state's $4.9 million LifeSaver Rx program that now provides free or reduced-cost medicine to more than 40,000 seniors. For approximately $250,000, the new program could pro. vide access to 130 drug assistance program covering 800 medications for up to 3 million people. The speaker says the benefits of the pro. gram "will far outstrip the costs."

Representative Carole Green expects bipartisan support for the bill. "It will truly help Florida's seniors," she says.

"One of the biggest issues with a huge senior population is their need for affordable prescriptions. What better way to solve the problem than to coordinate what is already in place."

But not every state has been successful in helping people get free medicines from manufacturers. Arkansas Representative Barbara King sponsored legislation in 2001 to create the Arkansas Pharmacy Outreach Program. It has been slow getting off the ground.

"Unfortunately, we're not moving forward on it as quickly as we'd like," she says. "We're trying to get a coordinated software program, but the doctors have to agree on it. It takes a lot of time."

COMPANIES ALSO RESPOND

Pharmaceutical industry organizations are also putting their best foot forward to help. PhRMA has launched a new Web program, HelpingPatients.org to hook patients up to thousands of drugs offered through hundreds of patient assistance programs.

Mark Grayson, one of its creators, says it's easier for people to get qualified through HelpingPatients.org, than through many state programs. "We have simplified the process as much as possible," he says. "Answers to just four questions let applicants know if they may qualify." After that, it gets a little tougher. "We can't make it easier because each company has different requirements, legal reasons and confidentiality statements," Grayson says.

While many citizens and legislators are optimistic about free pharmaceuticals providing demonstrable savings for consumers and the state, holes do remain.

Many people are on generic drugs, some 45 percent or more according to PhRMA and the Generic Pharmaceutical Association. And these already low priced products are not available through PAP programs.

AARP points out that not everyone who needs help can qualify for free medicines. "These programs can be useful to the extent that they give free drugs, but no one is sure how easy it is to qualify for them," says David Gross, senior policy advisor at AARP's Public Policy Institute. "They don't take care of all of the needs, by far, nor should they be expected to. A lot of people in need are not eligible."

DISCOUNTS HELP, TOO

If low-income seniors and patients do not qualify for the free patient assistance programs, they may qualify for a discount card or other program that reduces their costs. Some of the manufacturer discount cards and programs have a monthly, annual or application fee and requalification may be necessary over time. However, the savings can be monumental, saving patients up to 70 percent.

Some assistance programs target patients needing specific medications. For example, the Epilepsy Foundation tracks the five manufacturers that make anti-epileptic medications available to low income seniors and the disabled who do not have prescription coverage. In this case, if patients do not qualify for the patient assistance program, they may qualify for Pfizer's Share Card program.

Programs like the Share Card and Together Rx card provide a discount on pharmaceuticals by specific manufacturers. The Together Rx card represents eight major manufacturers and provides discounts for Medicare enrollees without public or private prescription drug coverage and with incomes up to $28,000 ($38,000 for couples). Sponsors claim savings are approximately 20 percent to 40 percent.

GETTING THE WORD OUT

Kentucky Senator Richard L. Roeding has taken it upon himself to disseminate information on 11 different pharmaceutical discount card programs for seniors.

"The biggest challenge with these programs is getting the information out to people," he says. "I've put packets in libraries, senior homes, extension offices and 1,000 copies in our Constituent Services office. Any of our 138 legislators can get copies from that office to use all over the state. I took politics out of this completely. This isn't a D or R situation. This is getting seniors their prescriptions."

MORE INFORMATION

PhRMA Web link to patient assistance programs and member companies:

* www.helpingpatients.org (For a printed copy of PhRMA member directory call (800) 762-4636).

Other patient assistance programs and related information:

* www.benefitscheckuprx.org (National Council on the Aging (202) 479-1200).

* www.rxassist.org/default.cfm (Volunteers in Health).

* www.rxhope.com

* www.medicare.gov

* www.medbankmd.org/ (Maryland's Medhank program (410) 821-9262).

* www.ncsl.org/programs/health/pharmlinks.htm#free (Additional NCSL information on public and private patient assistance programs and links to discount cards).

RELATED ARTICLE: FINDING FREE DRUGS FOR LOW INCOME AND ELDERLY PEOPLE

In the last three years, legislators have been playing a growing role in sorting out these valuable resources. So far, more than 15 states have passed legislation or created offices to coordinate free and discount drug programs from pharmaceutical manufacturers. Florida, Montana, Nevada, New jersey, Oklahoma, Oregon and Washington have proposed legislation for new clearinghouse programs.

The following states have passed laws or have bills pending to coordinate free and discount drug programs. Some have passed laws more than once. The map reflects the most recent action.

* 2003 bills- FL, MD, MT, NV, NI, OK, OR, WA,

* 2003 laws- ND, VA, WY

* 2002 laws-HI, IL, NH, NC, NM, OK, VT

* 2001 laws-AR, MD, MO, NM, OR, TX, VA, WI, WV

* 2000 laws- MA, NH

Karmen Hanson tracks pharmaceutical issues and programs for NCSL.