MU Extension MU Extension       University of Missouri    ●    Columbia    ●    Kansas City       Missouri S&T     ●    St. Louis

MissouriFamilies.org - Health

 

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.

 

 


University of Missouri logo links to http://extension.missouri.edu

Site Administrator:
mofamweb@missouri.edu
Copyright  ADA  Equal Opportunity


MissouriFamilies is produced by the College of Human Environmental Sciences,
Extension Division, University of Missouri

 

Last Updated 05/05/2009