Take charge of drug costs

THERESAMARY JOHNSON is supposed to take nine prescriptions each day -- 10 on Thursdays -- for lung disease, high blood pressure, osteoporosis, heart disease, rheumatoid arthritis and lupus.

Sometimes she does. Sometimes, she can’t afford to.

“I busted my buns to see I wasn’t in poverty in my old age, and I feel like I’m getting dragged right into it,” the 70-year-old Rio Linda, Calif., resident says.

Like Johnson, many Americans have trouble paying for prescription drugs. But as legislators, employers, insurance and drug companies wrestle with the issue, patient advocates say consumers could be doing more to lower their own drug costs.

In 2001, 12.7% of working-age adults with private insurance and chronic health conditions reported that they had skipped refills because of the cost; by 2003, that number had risen to 15.2%, according to the Center for Studying Health System Change.

Last year, more than 10% of the 39 million people enrolled in Medicare’s prescription drug plan paid out-of-pocket for drugs that potentially cost hundreds of dollars, according to the Kaiser Family Foundation.

For people without health insurance, the burden of prescription drugs is entirely their own. The Census Bureau reported last year that 46.6 million people, or 15.9% of those living in the United States, are without health insurance. An additional 16 million are underinsured and often spend more than 10% of their incomes on medical care, according to a 2005 survey by the Commonwealth Fund, a private foundation dedicated to improving healthcare practice and policy.

Republican and Democratic lawmakers in Congress are backing legislation to legalize drug imports from Canada and other industrialized countries, where they’re often cheaper, but such efforts are opposed by the Food and Drug Administration and the pharmaceutical lobby.

Meanwhile, the House has approved a bill that would allow the federal government to bargain over prescription drug prices for seniors and others covered by Medicare’s drug plan. Although under consideration in the Senate, President Bush has vowed to veto it, supporting a reliance on private enterprise instead.

As prescription drug sales rise -- up 8.3% last year to $274.9 billion, according to a survey released this month by IMS Health -- consumer advocates say patients need to start speaking up. With research, compromise and aggressive questions, many patients can reduce the amount of money they spend on prescription drugs.

When medicine bills get too high, “it is up to the patient to make the physician and pharmacist aware,” said Dr. Derjung Mimi Tarn, an assistant professor of family medicine at UCLA’s David Geffen School of Medicine.

Tarn illustrated that point in November with a study published in the American Journal of Managed Care. Her survey found that only a third of doctors discussed cost, insurance, supply, refills or money-saving generic drugs with patients when writing prescriptions. Only 2% of patients asked those questions, the study showed.

“Physicians aren’t always aware of patient costs,” Tarn said, “and patients are often intimidated or embarrassed to talk about cost issues with their physician.”

Nor are patients taking advantage of other easily available, cost-saving measures.

Health plans, for example, regularly offer mail-order prescription drugs, with a three-month supply often rivaling the cost of a one-month supply at a brick-and-mortar pharmacy. Consumers who used these mail-order plans are expected to save as much as $85 billion through 2016, according to a study by the Lewin Group prepared for the Pharmaceutical Care Management Assn., which represents these discount pharmacies. But if all qualifying maintenance drugs were ordered through these pharmacies, the savings could double, the study showed.

And millions of patients qualify for programs that could provide them with free drugs -- but are unaware of such assistance. Through the Partnership for Prescription Assistance, pharmaceutical companies and healthcare providers give free or low-cost drugs to the uninsured who make less than $41,300 for a family of four.

Since 2005, more than 3.5 million people have signed up for the program, said Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, an advocacy group for pharmaceutical research and biotechnology companies. But according to the Partnership, more than 29 million might have qualified.

“The real burden is on people who have multiple chronic illnesses who are taking lots of medications,” said Arthur Levin, director of the Center for Medical Consumers in New York, a nonprofit patient advocacy group. “They’re running up thousands of dollars in drugs costs.”

Johnson is covered by a prescription drug plan offered by Medicare, a federal insurance program for those older than 65 and others with disabilities. Her co-pays -- or her share of the prescription costs -- can run between $6 and $28 a month for each drug, and sometimes more, she said.

She must also cope with the “doughnut hole” in the Medicare prescription program. This quirk cuts off federal coverage for prescription drugs once a patient buys more than an allotted amount of medication in one year, which in 2007 is $2,400. Johnson must spend $3,850 out-of-pocket before coverage kicks back in. With 10 prescriptions, she -- like many seniors -- anticipates falling into that hole very quickly this year. Last year, the doughnut hole affected about 4 million of the 39 million subscribers to Medicare’s drug plan, according to the Kaiser Family Foundation, a nonprofit research group focused on medical issues.

As a result, Johnson said, “you experiment.” Some months she stretches out her drug supply by taking less than her prescribed daily dose. Other months, she’ll go days without taking a medication, restarting only when her disease symptoms become unbearable.

It was patients like Johnson who Tarn said inspired her to study the communication between doctors and their charges. As Tarn worked through her residency in family medicine, desperate measures like Johnson’s “really made me wonder what we could do better to help our patients, and made me wonder whether better communication could make a difference,” she said.

She, along with patient advocacy groups, pharmaceutical and insurance companies have developed strategies to help cut prescription drug costs. But as Tarn’s and other numbers show, many struggling patients might not know about them.

* For starters, talk to your doctor. Ask what the cost is of any new prescription and if a cheaper alternative is available.

“Doctors are really bad at identifying patients who have problems with cost,” Tarn said. But when asked, physicians can often help patients find a less expensive drug with the same benefits. This applies to both insured and uninsured patients; many drug insurance plans offer cheaper co-pays for generic or older brand-name medications.

* Make sure you really need all your medications.

Premera Blue Cross of Washington encourages subscribers to carry a brown bag to their doctors’ offices holding all vitamins, drugs and other supplements. Go through the contents with your doctor to make sure each one is necessary. A voluntary survey of 11,000 Premera participants showed that 44% received dosage changes and 36% were advised to stop taking at least one existing medication after discussing the drugs with their doctors.

* Consider generic drugs. Under federal law, generics must work in the same way and carry the same benefits and risks as their brand-name counterparts. But they often cost significantly less.

Because makers of generic drugs don’t have to recoup money spent on creating a drug from scratch, they don’t charge as much for the final product.

Although the creator of a drug can usually hold a patent -- and thus a monopoly -- on a product for 17 years, generic versions are available after the patent expires. The popular antidepressant Zoloft, for example, costs $88.19 for a 30-day supply of 100-milligram tablets on drugstore.com. Its generic equivalent, Sertraline HCl, runs $68.99 for a month’s supply at the same strength.

* Comparison shop. Prices often vary dramatically by store.

“In a lot of cases, there can be some pretty significant differences between what one pharmacy charges and another,” said Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturers of America, an advocacy group for pharmaceutical research and biotechnology companies. For example, Diovan, a popular brand-name blood pressure medication, sells for $90.99 at Walgreens.com for a month’s supply of 320-milligram pills.

The same prescription at drugstore.com, which works with Rite Aid pharmacies, costs $83.18. Always make sure an online site requires a prescription, has a pharmacist you can ask questions and is licensed by the state board of pharmacy where it is located. For a list of state boards, visit www.nabp.info.

* Split pills. Ask your doctor if your medication can safely be cut in half. If so, a prescription for a double-dose pill might not cost much more than for a single dosage.

At drugstore.com, for example, a month’s supply of 160-milligram Diovan pills costs $63.66; customers can buy pills twice as strong for $83.18 per month. For those with insurance, the difference can be an entire co-pay. In 2005, UnitedHealthcare, the nation’s second-largest health insurer, issued pill splitters to subscribers to help them cut drugs and costs. Not all drugs can be split, though, so always check with your physician beforehand.

* Make sure a new prescription works for you and doesn’t carry harmful side effects before buying a large supply.

Many pharmacies will fill a week’s supply if asked when you drop off a new prescription. This trial run will give you a chance to assess the drug’s efficacy and potential problems before spending money on something that might not work.

* Learn if your insurance plan supports a mail-order pharmacy. If so, you can often order a three-month supply of maintenance drugs at the same co-pay as what one month would cost at the neighborhood drug store.

* If you don’t have insurance, check out a Patient Assistance Program or drug discount card.

PhRMA will link uninsured patients who earn up to 200% of the federal poverty line -- or $41,300 for a family of four -- with free or nearly free prescription drugs, Ken Johnson said. The group’s website, www.phrma.org, links patients with a clearinghouse to 475 assistance programs providing 2,500 medications. Since 2005, drug companies have given away $5 billion worth of prescriptions.

* If you are uninsured but make too much money to qualify for the assistance programs, ask if your drugstore accepts a discount card. Insured customers won’t qualify.

But qualifying uninsured patients can save 25% to 40% on 300 brand name drugs with cards like Together Rx Access, a consortium of 10 pharmaceutical companies that offer medication for diabetes, high blood pressure and depression, among other things. Talk to your pharmacist to see what cards are accepted at your pharmacy and cover your drugs.

* Check if your pharmacy offers generic drugs at a flat reduced rate. Both Wal-Mart and Target pharmacies sell hundreds of generic drugs for $4 each for a 30-day supply. Drugs to treat allergies, Parkinson’s disease and arthritis are among those included.

* Comparison shop before crossing the border.

Although drugs in Mexico and Canada seem cheaper than those in the U.S., consider how much you will spend in travel costs or shipping, and how much you could save by using a discount plan at home. According to the FDA, the savings often are not as high as they might seem.

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A variety of lower-cost options

The following chart compares drugs purchased through large American pharmacies with those bought at the popular Canadian Web site, Canadadrugs.com:

*--* DRUG Walgreens Drugstore.com Canadadrugs.c Costco om Zocor* $149.99 $146.99 $83.70 $147.52 Zocor generic $89.99 $22.98 $43.80 $10.86 Zoloft ** $93.99 $87.14 $54.61 $82.24 Zoloft generic $73.99 $67.99 $31.20 $6.32 Ortho-cyclen 28 $49.99 $44.99 $24.60 $45.80 Ortho-cyclen $29.99 $25.99 $24.60 $21.43 generic

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*30 day supply, 80 mg tablets

**30 day supply, 50 mg tablet

-- Genevieve Bookwalter