For all the hoopla about Medicare's new drug benefit, one unpleasant side effect is bound to cause consternation: The pharmaceutical industry will soon cut back on many of its free or reduced-price drug programs.
That's right: free drugs. Not too many people know about them. And people sometimes have to jump through hoops to get them. But in the past few decades, the drug industry has quietly filled about 40-million prescriptions for 6-million people at little or no charge, an industry spokesman says.
These are not samples, handed out by doctors, but honest-to-goodness prescriptions filled under "patient assistance" programs. And they have been a godsend to needy people on Medicare.
Eli Lilly and Co., for example, has filled 2.2-million brand-name prescriptions to 380,000 Medicare beneficiaries at a flat rate of $12 per prescription, spokesman Ed Sagebiel says.
The program is called LillyAnswers and is designed for Medicare beneficiaries with annual incomes of less than $18,000 ($24,000 for a couple).
Like other manufacturers, Lilly limits its largesse to people who cannot get drug coverage elsewhere. People on Medicaid can't qualify. Nor can veterans served by the VA, nor retirees covered by a former employer's health plans.
Now, with Medicare beginning drug coverage Jan. 1, people with low incomes can join a Part D drug plan while paying little in the way of premiums, deductibles and copayments.
So LillyAnswers will stop enrolling people Jan. 1 and stop filling prescriptions on May 15, Sagebiel said.
"We believe the Medicare benefit should pick up where LillyAnswers leaves off," Sagebiel says.
Lilly is not alone. An industry Web site lists more than 100 patient assistance programs and almost all of them limit their assistence to people who cannot get drug coverage through other means.
"We haven't determined yet what will happen to our patient assistance program in 2006," said Patty Seif, spokeswoman for GlaxoSmithKline, which offered reduced-price drugs to 475,000 people last year. "But we will definitely be communicating with (people on the program) and we are encouraging seniors to apply for Medicare Part D."
Merck offers patient assistance to people whose incomes are less than $19,140 ($25,660 for couples). People who sign up for a Medicare Part D drug plan will no longer qualify as of Jan. 1, said spokesman Christopher Loder. Medicare beneficiaries who reject Part D coverage, however, can still get Merck drugs such as Zocor and Fosamax through the company.
"Merck encourages all seniors to consider enrolling in the Medicare prescription drug benefit," Loder said. "This new benefit may help seniors get better coverage of all of their medicines - not just Merck medicines."
Bristol-Myers Squibb takes the same position. People who sign up for Part D will no longer get free or reduced priced drugs. Johnson & Johnson is notifying doctors that patients must first be turned down for Medicare's "special help" subsidies under Part D before they can apply for Johnson & Johnson's program.
Another popular industry program - the Together Rx discount card - is also ending.
Florida's SHINE program, a volunteer group that advises older people on insurance issues, faces a quandary when balancing the merits of Medicare vs. patient assistance programs, said Bob Archer, a SHINE coordinator.
In the past, SHINE has helped more than 5,800 people sign up for free or reduced drugs from the manufacturers, but now those programs are in limbo, Archer said.
"The drug companies want to be secondary" sources of drugs, he said. "They don't want to be primary."
For now, SHINE tells lower-income people they can still get free drugs this month. After that, it's unclear.
For low-income people with few assets, Medicare Part D plans are probably a better deal anyway. For these people, Part D premiums and copayments are minimal, and Medicare plans cover broad ranges of drugs. Under patient assistance programs, people must apply separately to each manufacturer.
Also, anyone on traditional Medicare who rejects Medicare Part D now will pay a stiff premium penalty if they want the drug benefit later. Patient assistance programs carry no guarantees and could end at any time.
However, some low-income people have nest-eggs: a few stocks, CDs or a savings account. If those liquid assets top $11,500 ($23,000 for a couple), then people cannot qualify for Medicare's low-income subsidies, and Part D premiums and copayments can consume a large portion of their monthly income.
The Kaiser Family Foundation estimated that 2.4-million people on Medicare can meet the income test for low-income subsidies but cannot qualify because they have too many liquid assets.
Patient assistance programs only look at income, not assets. So they are a boon to the people who won't qualify for low-income assistance under Medicare.
Sagebiel said Eli Lilly wants to continue helping such people even though the LillyAnswers program is ending.
"We recognize there could be gaps for some patients," Sagebiel said.
One idea: Have Lilly defray Part D copayments on Lilly products for low-income people who don't otherwise get a break from Medicare. Medicare would have to approve that arrangement and Lilly expects an answer in the next two to nine months, Sagebiel said.
Any cutbacks in patient assistance programs probably would apply only to people on Medicare, because they will have new options, said Jeff Trewhitt, spokesman for PhRMA, the industry trade group. Other age groups can still turn to the industry as a last resort.
"Uninsured patients not on Medicare are still going to need help as of January 1."
- Information from the New York Times was included in this report[Last modified December 3, 2005, 16:23:04]
