Beg, Borrow, or Steal: A Search for Affordable Prescription Drugs
Posted on January 5, 2008
Filed Under Pharmacy (PharmD), Medical (MD, DO)
by Emily Forest
SDN Staff Writer
Seroquel, with its connotations of well-being and peace, sounds like the name of a bird or a midlevel car. It doesn’t sound like something that causes weight gain or blurred vision while treating psychosis, nor does it sound like something associated with financial strife. The pills, tiny, white and innocuous, don’t LOOK expensive. But at nearly $600 for a month’s supply, the cost easily exceeds rent for many people.
When I started the drug, I dutifully paid the $30 co-pay and let my insurance company handle the bulk of the cost. What I didn’t realize was that each month, behind this co-pay, the insurance company received a bill for $595.00, whittled down to a “negotiated rate” of $498. While I took for granted that my insurance company shouldered the burden of my monthly costs, both for Seroquel and several other psychotropic drugs, I didn’t realize that the benefit had an annual cap of $2,500.
I came to this realization a few months into my policy year when my pharmacy bill, usually under $200, mysteriously quadrupled. After leaving the pharmacy in tears, minus my drugs, I called my doctor to bewail this misfortune. I called my father to ask for money, and I started an Internet search for solutions. I’d heard about Canadian pharmacies and cheap drugs, so I focused my efforts there.
A Google search for key words Canadian Pharmacy yielded over 8 million results with just about every iteration of the words Canada, Pharmacy, Drugs, and Prescription. The pharmacies boasted “discounts of up to 70%,” “easy ordering,” “legality,” and they featured pictures of smiling, care-free gray-haired seniors.
Eager to take advantage of “savings up to 70%,” I went to one of the web sites where Seroquel, sold as generic quetiapine, was available for $99.00. Before completing the purchase, I had to fill out my primary physician’s name, phone number, medication list. I had to answer a series of yes-no questions about whether I was a smoker, had arthritic disorders, glaucoma, etc. I sent my prescription with payment and received my 90-day supply of quetiapine.
The legality of the importation of such drugs is called into question by the federal Food and Drug Administration. Any drug manufactured in the United States cannot legally be imported from another country (21 U.S.C. § 381(d)(1)). Also, any drug not approved by the FDA (21 U.S.C. 331(d) 355(a)), nor any incorrectly labeled drug may be imported (21 U.S.C. § 353(b)(2)). http://www.fda.gov/ora/import/kullman.htm. It is, however, legal to import drugs which are approved by the FDA, not manufactured within the U.S., and which bear correct labeling. There is a stipulation making legal the import of experimental treatments of serious diseases given that these treatments do not pose a serious risk. http://www.fda.gov/ora/import/traveler_alert.htm
Most drug companies do offer aid to individuals unable to afford prescriptions. Generally, patients must submit an application to the necessary drug company explaining their lack of income, insurance, savings, and just about any other means to pay for drugs.
Any denied claims may be appealed, accompanied by a detailed letter describing the inadequacy of the insurance, income, and savings in the face of mounting health care bills. Those who are poor and adequately persistent may be supplied with free drugs.
Finally, drug samples often are used to satiate patients. While organizations such as No Free Lunch condemn the use of lavish dinners, pens, samples, and any number of ploys meant to influence physicians, these items are heralded as useful to those who cannot afford dinners, those who need pens, and patients who cannot afford their drugs. Samples are not intended for use by those unable to afford drugs, although this does happen.
During my own quest for affordable medications, I broke federal laws, I groveled, and I misused drug samples. Due to the obvious stigma associated with my desired pills, I found myself additionally handicapped. If I’d been attempting to eradicate pimples, erectile dysfunction, or joint pain, I would have felt more comfortable asking for advice and help — or, at least, moral support. But I worried that if I spoke of MY problems, I’d field questions about the exact nature of my illness, the specific drugs involved, etc.
I’ve managed to convince AstraZeneca and other drug companies that I qualify for their charity programs. I have a steady supply of free, legal drugs. And, more importantly, I’m aware of some of the obstacles future patients of mine may face. Even though I don’t plan to become a psychiatrist, I’m more aware of the needs and potential problems patients suffering from any chronic medical problem.
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5 Responses to “Beg, Borrow, or Steal: A Search for Affordable Prescription Drugs”
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“Free” drug samples are anything but free. Pharmaceutical companies keep close tabs on the value of the samples that they distribute to physicians, and they factor those marketing costs into the price of their drugs. Those samples are a marketing tool, not a charitable donation.
When patients need a medication for a chronic condition (HTN, DM, psych disorders, etc), and the physician starts them on a more expensive brand-name medication (instead of a cheaper and more appropriate generic that works just as well) because they have some samples in the cupboard, they do their patients a disservice. When the patient runs out of the samples, in order to keep taking that med, he/she will now be stuck with the burden of that huge pharmacy bill (like the $595 per month for Seroquel mentioned above).
On the other hand, the Patient Assistance Programs that many pharmaceutical companies have, through which patients can receive needed medications for free if they financially qualify, are a much better alternative to free samples. Such programs allow patients to obtain needed meds, but without creating undue influence on physicians to prescribe inappropriate drugs.
Just out this week: Poor and uninsured patients are the ones least likely to get those “free” drug samples
http://www.acponline.org/weekly/2008/1/8/index.html#samples
I graduated college a year and a half ago with plans of going on to medical school or PA school. In the meantime, I’ve been serving with AmeriCorps(like a domestic PeaceCorps) at a community health center in Milwaukee. Every day, I assist uninsured, low-income patients to obtain medications treating numerous diseases and conditions, ranging from asthma, depression and diabetes to Hepatitis C and cancer from pharmaceutical company-sponsored patient assistance programs. Being in this position has truly opened my eyes to the plight of the medically uninsured and underinsured. There is free or low-cost medication out there for the taking, if only those who need it know where to find it and how to gain access to it.
Unfortunately, in my experience, it seems that many clinicians either have little or no knowledge of these programs themselves or are too busy to help their patients to do the necessary leg-work to gain entrance into them. All those out there who are just beginning their careers in medicine or pharmacy, take the time to at least learn about what’s available in terms of medication assistance. Your responsibility shouldn’t just end with writing a prescription…if your patient cannot obtain the medication you prescribe because of financial burdens, they will continue to suffer.
For more info on Patient Assistance Programs, check out: www.rxassist.org
Unfortunately, KB, in today’s environment we often need to see at least 4 patients per hour to “keep the lights on.” We must review the patient’s previous information, complete the history, do a physical exam, perform medical decision-making and write up all of our findings and arrange prescriptions, referrals, tests, and follow-ups–this within 15 minutes. At the same time, reams of phone calls and faxes such as refill requests, patients’ questions, rejections from insurance companies for medications not on their particular formularies, etc., etc., pile up on our desks.
In the past, I have tried to guide patients to these programs, but even a full 15 minute appointment was often not enough to fill in all the paperwork they expected me to do. The office could hire more personnel to help, but that means of course that we must see MORE patients in the same amount of time in order to pay more salaries and benefits.
I used to think things were simple, and if folks only cared more and tried harder, we as physicians could take care of everything for all our patients. Then I hit the real world, or I guess it hit me!
Former pfizer sales rep turned post-bacc pre-med -from a “behind the scenes” perspective, pharma is one ugly, despicable business (took me a few years to figure it our because of all the brainwashing that takes place internally). The manipulation taking place should be stopped immediately patients are being put at risk. Even the most astute dedicated, patient focused MD has the possibility of giving into the manipulation that representatives are conducting daily. Companies spend millions and millions of dollars on training tactics -we would sit in rooms for 10hrs a day for a week discussing each MDs concerns, aspirations, personality, motivations, etc in order to be able to persuade them more appropriately to our agent vs. the competition. I am appalled that this practice is still allowed to happen - check out Money Talks: Profits Before Patient Safety at www.moneytalksthemovie.com.