by Peter J. Nebergall, Ph.D.
Photo included; Caption: Peter J. Nebergall
The Problem
About a year ago, a widely-publicized international study ranked American health
care 37th in the world, principally because it was not "universal,"
or "single-payer," as in nearly all other developed countries. One
of the survey's authors observed: "Poor health is the biggest producer
of new poverty in the United States." Our doctors and hospitals may be
very good indeed, but our "safety-net" has holes in it—and if
you have diabetes, you've probably found a few of those holes already.
The direct medical costs of diabetes in the U.S.A. (the money we pay the doctor,
the hospital, and the pharmacist) run about 44 billion dollars a year, according
to the U.S. Centers for Disease Control. That works out to $4000 dollars per
diabetic per year—above and beyond our already high general health costs
and fees. That's a hardship for a lot of people—especially if you receive
an hourly wage, and don't have a fantastic "benefits package."
If you're old enough or sick enough to qualify for Medicare, you'll have found it covers a lot, but not everything. If you have private insurance, it may or may not be adequate for your needs, and the HMOs, desperate, drowning in red ink, are cutting back wherever they can. Millions of people have no prescription coverage, or no medical coverage at all. How do we pay for what we need—now? Although we can't address "paying for the doctor" today, there are options, if you need some help paying for your diabetes medications.
Paying for Medications
Outside of Medicare, Medicaid, and private insurance, there are a few alternatives
to paying list price out of pocket—maybe more than you think. Drug manufacturers
Pfizer and Eli Lilly offer "discount cards" for individuals eligible
for Medicare (SSI or SSDI) who meet their income requirement (less than $18,000
individual or less than $24,000 family) and who have no other prescription drug
coverage. These cards allow a user to purchase a month's supply of any of the
issuer's products, for a low set fee ($12 to $15 per med per month). Naturally,
a drug company's card will only help you with products distributed by that drug
company.
There are several others, but the private "subscriber" cards generally offer only small discounts, and some of them (according to a recent U.S. government. survey) may not offer any discount at all. If your meds are from Pfizer or Lilly, these cards look best from here:
PFIZER ("the Share Card")
Effective March 1, 2002, holders of this card can purchase a 30-day supply of
any listed Pfizer prescription product, for a flat fee of $15 each. For many
drugs, this is a major discount. As Pfizer makes both type 2 diabetes medications
and other drugs that treat common diabetes complications, this news should be
of great interest. The Pfizer Share Card can be used at retail pharmacies, such
as CVS and WalMart. Look for more pharmacies to join the program. For more information,
or to receive an application, telephone: 1-800-717-6005, or see the Web site:
www.pfizerforliving.com
ELI LILLY ("LillyAnswers Card")
Similar to the above, includes many diabetes medications. contact Lilly at 1-800-545-6962.
The PhRMA group, for medication assistance
The pharmaceutical industry has a tradition of providing medications free of
charge to physicians whose patients might not otherwise have access to necessary
medicines. Members of the Pharmaceutical Research and Manufacturers of America
(PhRMA), an association of drug manufacturers, have created a directory listing
each participating manufacturer, and the products that manufacturer has decided
to list. Eligibility rules vary between manufacturers, and all prescription
medications are not included, nor are all drug manufacturers members of PhRMA.
Still, the association's patient assistance program (which does include insulin,
oral diabetes medications, and cyclosporine) is a useful safety net. PhRMA's
directory is in fact quite extensive.
Transfer of prescription medications is regulated by many laws. Upon approval,
medications are shipped to the prescribing physician. For information, and a
copy of their Directory of Prescription Drug Patient Assistance Programs, physicians
should contact: PhRMA, 1100 Fifteenth Street NW, Washington DC, 20005; telephone:
(202) 835-3400. Alternatively, the directory may be downloaded from their Web
site: www.phrma.org.
Web site: Diabetes-Meds.Org
Diabetes-Meds.Org (www.diabetes-meds.org)
is a Web site designed as a clearing house to link doctors and needy patients
with the appropriate drug-company program for free or low cost medications.
Although this service is NOT tied to Medicare eligibility, its income limitations
are the same as those for the Pfizer and Lilly discount cards (Less than $18,000
single or less than $24,000 family).
Prescription Drug Help
If you have prescription medications, and you can't afford them, you may know
a number of manufacturers provide free medications—but the problem is finding
the right one, and then completing the paperwork. If you qualify (low income,
no prescription coverage), The Health and Wellness Educational Center will help
you find your necessary prescription medications, and will help with the paperwork.
Contact: (205) 652-6557.
MEDICARE has its own consumer website: (www.medicare.gov), offering a prescription
drug assistance program that searches online for public and private programs
that offer discounted or free medications.
Conclusion.
Is it "Your money or your life?" No. It's not that bad. There are
options. If you do the legwork, if you meet the income guidelines (which are
pretty reasonable, when you do the math), there are alternatives out there.
It may take you some time, but they're out there.
What should we be doing? We should be joining the rest of the world, with a
national health service, guaranteed basic access, and price controls on basic
medications. Initiatives like Pfizer's SHARECARD are commendable, but they are
stopgaps, and the companies know it. "Until the Administration, Congress,
and the states design an appropriate, high-quality, long-term solution ... we
are bridging the gap," says Pfizer.
Here's hoping Pfizer's competitors, and the government, quickly follow their
example.