Drug Aid Not Getting to Indigents : Pharmaceuticals: Doctors serving low-income and elderly say they are not getting information on the plans.

Recent congressional attention to the high cost of prescription drugs has focused attention on little-known programs established by pharmaceutical companies to distribute millions of dollars of free drugs to indigent patients.

However, many physicians say they are still unaware that such programs exist. That could prevent many poor patients from receiving needed medication, since doctors must apply for the aid.

The Pharmaceutical Manufacturers’ Assn. said it recently stepped up efforts to publicize the programs, including advertising in medical journals. And some drug companies say they have created informational kits to be distributed by their salespeople.

But some doctors, in particular those serving low-income areas where the demand could be greatest for free drugs, say they have not heard of the aid programs, although they have daily contact with representatives of pharmaceutical companies.

“You mean to tell me . . . nobody’s telling me about this? Every day three (pharmaceutical) reps come to see me,” said an angry Dr. Accie Mitchell, a family practitioner at the Florence-Western Medical Clinic who said some of his patients do not take the drugs he prescribes because they cannot afford them.

Free drugs are offered by at least 37 major drug companies, including Merck, Pfizer and Marion Merrell Dow. Some offer only certain drugs free, while others offer their entire product lines. In general, the programs require a doctor to write a letter stating that a patient cannot afford a drug and is not covered by Medicaid or other insurance. Then either a several-months’ supply is sent to the doctor, or the patient is given a voucher that can be taken to a pharmacy.

The assistance is a boon especially to senior citizens, who often have chronic conditions and huge monthly drug bills. Medicare does not cover prescription drugs.

Several recent government and private studies have shown that drug prices far outpaced the rate of inflation during the 1980s.

“We’re coming in to fill the gap to help people neglected by everyone else who should be helping them, like state and federal agencies,” “ said Richard Vastola, director of Pfizer’s assistance program for indigent patients. He said his company is considering targeting information to reach doctors in low-income areas.

Many doctors who serve low-income and elderly people say they give away the free samples of drugs distributed by drug companies for promotional purposes.

Sometimes they ask for extra samples to help out patients who can’t afford drugs, and salespeople generally provide them.

“I’m not familiar (with the aid programs). I see the pharmaceutical reps regularly, but not one has mentioned it,” said Dr. Richard Iwata, who serves a largely elderly population in Little Tokyo, some of whom have difficulty paying for expensive drugs out of pocket. “I have to temporize and think about the economy every time I prescribe a drug,” he said.

Dr. Rayfield Lewis, a physician in South-Central Los Angeles, says he’d never heard of the programs, though those of his patients not covered by Medicaid often have difficulty paying for prescription drugs. “They should send some literature to doctors,” he said.

Doctors interviewed in more affluent areas, ironically, were more familiar with the programs, which they said pharmaceutical representatives had told them about. “I maintain a file in my drawer on the programs,” said Dr. Robert Davidson, an internist with offices at Cedars-Sinai Medical Center.

“The pharmaceutical reps always come by and tell us about (the programs),” said Dr. Harold Karpman, who has a practice in Beverly Hills.

The pharmaceutical companies’ promotions for the drug aid programs have been directed at physicians, but consumers who have learned of the aid have responded in droves.

Who Can Qualify

Many drug companies offer physicians free drugs for needy patients. Individual manufacturers’ requirements for assistance vary, but there are some common requirements:

Patients can’t be covered by Medicaid or a private insurance plan that has prescription drug coverage.

Physicians must apply on behalf of patients, in some cases providing a statement of the patient’s financial hardship.

Generally no more than a three months’ supply is available at one time, but requests may be renewed.

Sources of Information

Patients seeking an alphabetical listing of drugs covered by specific companies, including information on assistance for AIDS drugs, may contact: The Senate Special Committee on Aging, Dirksen Senate Office Building, Room G-31, Washington, D.C. 20510, (202) 224-5364.

Physicians seeking a directory of manufacturers’ assistance programs may write the Pharmaceutical Manufacturers’ Assn., 1100 15th Street N.W., Washington, D.C. 20005.

Sources: Senate Special Committee on Aging, Pharmaceutical Manufacturers’ Assn.