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Doctors—especially those practicing in low-income areas—oftensee their patients squirm with the news that they need another prescriptiondrug. For some patients, the out-of-pocket costs for medications are sosignificant that it comes down to buying prescriptions or food.
The burden of out-of-pocket health care costs can be especially tough forpeople with type 2 diabetes. At the last American Diabetes Association (ADA)Scientific Sessions, Leonard E. Egede, MD, and Paul J. Nietert, PhD, reportedthat people with diabetes are spending significant amounts of money out oftheir own pockets on health care.
"People in lower income brackets spend higher proportions of theirtotal income on health care compared with people in higher incomebrackets," saysNietert.
Nietert and Egede, of the Medical University of South Carolina, showed thatpeople with diabetes making less than $10,000 a year were spending an average$2,170 out-of-pocket for health care, including medical care, prescriptions,and home health service.
There is help, however, in the way of price breaks on prescription drugs.The help can come through state and other government programs, as well as fromthe pharmaceutical companies themselves.
Doctors who know about prescription assistance programs can pass on theinformation to their patients who qualify. Some doctors' offices go so far asto help patients fill out and submit the paperwork. The result? Depending ontheir incomes, some patients get prescription medications for free, whileothers get more affordable reduced rates.
BEING IN TUNE TO PATIENT NEEDS
In his practice serving the indigent Medicare population of East Harlem,N.Y., Valentine J. Burroughs, MD, knows the problem of out-of-reachprescription drug costs.
Burroughs, an endocrinologist, and medical director and chairman ofmedicine at North General Hospital in New York City, says doctors have to bein tune to patients who might not readily admit that they cannot afford theirmedications.
If he doesn't warn patients up front, Burroughs says he usually "getsan earful" after he has prescribed medicines. Patients, suffering fromsticker shock at the next visit, might then divulge their inability to affordprescriptions.
"I think the doctors have to be aware of whether or not theirpatients are taking medications. And if they ever get the sense that theirpatients are not taking the medications because they can't afford them, thatdoes not let the doctor off the hook," he says.
A HELPING HAND
Burroughs and his staff help patients find financial relief by steeringthem toward programs offered by major pharmaceutical companies. The programsoffer reduced-rate or free prescription drugs to those who apply and areincome eligible.
"All major pharmaceutical companies have these prescriptionprograms," Burroughs says. "[Many] are targeted toward indigentelderly patients who don't have a drug benefit plan."
Burroughs' office collects information from drug company prescriptionassistance programs and helps patients identify those that could help based onwhich drugs they are taking.
The programs can make a dramatic difference, according to Burroughs, whosays he has seen monthly out-of-pocket costs of two drugs totaling $300slashed to $30 with the aid of prescription assistance.
Mark Grayson, deputy vice president, Pharmaceutical Research andManufacturers of America (PhRMA), a trade group representing more than 90% ofthe brand name sales in the U.S., says each company has its own patientassistance program.
"There are a lot of Medicaid and state pharmacy assistance programs,and you can find out about those programs [on the PhRMA website], as well aswhat the industry does," Grayson says. "States don't do very muchin explaining programs available to people who fall through thecracks."
Drug companies are doing their part to make the hunt for these programseasier on office staffs and patients.
In October 2004, Pfizer announced that the uninsured could begin fillingtheir prescriptions at significant savings at more than 52,000 communitypharmacies nationwide or through the company's mail-order service.
The initiative is part of Pfizer's Helpful Answers program for people notcovered by a prescription benefit plan. Patients with Medicare prescriptionbenefits may also be eligible.
Families earning $31,000 or less annually qualify for free Pfizermedications; families earning $45,000 or less a year qualify for savings of upto 50%; and families earning more than $45,000 a year can save up to 25%,according to the company.
HELP IN THE CLINIC
Richard Hellman, MD, has also made it his and his staff's business to helppatients find and secure prescription assistance.
Hellman, a practicing endocrinologist in North Kansas City, Mo., treasurerof the American Association of Clinical Endocrinologists (AACE), and clinicalprofessor of medicine at the University of Missouri-Kansas City School ofMedicine, purchased a software program called RX Assist, which helps cut someof the paperwork associated with signing up for prescription assistance.
"[The software] allows us to download the forms that the variouscompanies require for the patients to fill out," he says.
According to Hellman, in most cases, patients or their legal guardians haveto fill out patient information sections requiring income data anddocumentation. His staff then fills out the medical information.
While these programs help patients, they require varying amounts ofdoctors' and office staffs' time.
"I estimate that in our practice it costs us probably close to $100per patient per year to provide this benefit," Hellman says. "Butwe view it as a service that helps the patient and it certainly helps therelationship between the patients and our office."
INVOLVING THE PATIENT
Health professionals who help patients with the paperwork for prescriptionassistance programs say that patients have to be involved in the process.
If doctors try to assume too much of the responsibility, the good deedmight backfire, says Miriam Cavnar, MA, a medical assistant who helps patientswith prescription assistance at East Coast Medical, an endocrinology practicein Boca Raton and Delray Beach, Fla.
"People want to make it your problem when it's their problem,"she says.
Cavnar is careful to emphasize that she is happy to help with the forms andsend them in, but patients must take responsibility for accurately filling outtheir information and providing the necessary financial documents. She says ifforms are not completed accurately, they are returned by the pharmaceuticalcompany, causing more time and frustration for the doctor's office andpatient.
Physicians and staffs should know to ask patients if they qualify forMedicaid, which covers prescription drugs. If they do, that can greatly reducetheir out-of-pocket costs.
Even when they do everything right and efficiently, doctors' staffs have toinvest some time in learning about the available resources and helpingpatients through the processes. But the time is well worth it and a provider'sresponsibility, some believe.
According to Hellman, some of his patients would not be alive today if notfor prescription assistance. 
Footnotes
www.helpingpatients.orgWeb site provided by the Pharmaceutical Research and Manufacturers of America(PhRMA) to help people get information faster and eliminate some of thepaperwork.
www.pfizerhelpfulanswers.comProgram run by Pfizer that can also be accessed by calling tollfree (866)706-2400.
www.benefitscheckupRX.orgHelps patients sift through their options.
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