Monday, November 15, 2010

Uninsured Americans cannot afford many

I went to the doctor recently and got a new prescription.

The doctor was kind enough to give me some free samples, and a voucher that I could redeem to fill the prescription once at no cost. In the future, it will cost me $50 if I decide to refill it. If I didn’t have pharmaceutical benefits through my insurance coverage, the medication would set me back about $500 for a month’s supply. For those of you doing the math, yes, that’s $6,000 a year. Suffice it to say that I wouldn’t be filling the prescription. And that’s exactly what many Americans do.

For many low-income uninsured Americans, a number of important medications are out of reach because they are simply unaffordable. These are medications that treat chronic diseases like hypertension, high cholesterol, and other common illnesses. They are effective medications that can make a huge difference in a person’s quality of life–including whether or not they die an avoidable death. In a show of good faith, most pharmaceutical manufacturers provide access to no-cost or reduced-cost brand name medications (the ones they manufacture, of course) to this “gap” population. The trouble is, few people know about these programs, which offer tremendous assistance, but require people to jump through a number of application hoops to qualify for the cheap or, in some cases, free meds.

Dr. Heather Whitley has an article out in the latest issue of The Journal of Rural Health, which attempts to quantify the value of these prescription assistance programs (PAPs) at a clinic in Alabama. Head south from Tuscaloosa, and you’ll find yourself in Hale County–one of the 50 poorest counties in America with an average annual income of $14,927 per person. In Hale County, is a town called Moundville, and it is here that the Moundville Medical Clinic operates with a single physician, a nurse practitioner and a couple of nurses. This is one of those places that most Americans don’t know–or at least really don’t like to acknowledge–exists in the United States. If ever anyone needed help obtaining prescription medication, the patients of the Moundville Medical Clinic would be first in line.

The clinic has a pharmacist who works two days a week to help patients navigate the PAP application process. Costs are offset by charging patients $5 per completed and mailed application. In most cases, that is a small price to pay. Dr. Whitley looked at the data collected by the clinic to assess the value of the program–that is, how much free or reduced-cost medicine were patients getting?–and found that across a two-year period (2007 and 2008), the PAP program at the Moundville Medical Clinic brought in more than $138,000 in free medications.

That’s a lot, yes, but what is even more striking is when you consider that that was only for a total of 31 patients. In other words, each patient received about $4,500 in free medication on average during the study period. That’s a pretty remarkable benefit in return for filling out some complicated paperwork, and it suggests that — until real health reform and cost-control is achieved — clinics that see a number of PAP-eligible patients should strongly consider investing in such programs, even if it means having someone volunteer their time one day a week. The benefits far outweigh the costs, but there are administrative hurdles that must be cleared before the benefits can be accessed.

Brad Wright is a health policy doctoral student who blogs at Wright on Health.


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