Drug costs: prescription for poverty Industry blamed for soaring prices

April 22, 1993|By Michael Dresser | Michael Dresser,Staff Writer

Lola Oriente, whose blood pressure recently measured a dangerous 196 over 115, isn't taking her medicine any more. She's trying garlic pills instead.

An energetic woman of 70 who still teaches tap and ballroom dancing, Mrs. Oriente decided "this medication business is for the birds" after three years of paying $90 every few months for a prescription of the hypertension drug Vasotec.

With a $22,000-a-year annual income and a husband whose own heart condition requires $200 worth of prescription medicine a -- month, Mrs. Oriente decided a year ago that she would rather take her chances on a stroke or heart attack than live like a pauper. "I just tolerate the high blood pressure," she says.

After a decadelong run-up in the cost of medicines, millions of Americans approach their corner pharmacy with a sense of dread. Many say they can no longer tolerate the financial pressure.

Their complaints have made prescription drugs and how to control their costs one of the touchiest issues facing Hillary Rodham Clinton's task force as it studies reform of the nation's health care system.

Prescription drugs account for between 5 percent and 10 percent of the nation's health care bill, depending on who's talking. However, prescription drug costs create a disproportionate problem for the approximately 50 percent of Americans who pay for medicines out of their own pockets.

The burden falls especially hard on the elderly, many of whom take four or five prescription drugs at any one time. According to a study for the American Association of Retired Persons, the older people are, the less chance that they will have insurance that pays for prescriptions.

Drug prices are a particularly sensitive issue for Mrs. Oriente of Overlea and other seniors at the Harford Center for Senior Citizens, located in middle-class Northeast Baltimore.

Charles Pasqua, a 69-year-old retired chef in Baltimore, reaches into his wallet and pulls out a worn booklet that lists the medicines he takes for a heart condition. There's Coumadin, a blood thinner that increased in priced by 159.4 percent from 1987 to 1992; Lanoxin, for heart failure, up 95.8 percent from 1985 to 1990; as well as Capoten, Voltaren, Furosenide and Micro potassium.

Mr. Pasqua and his wife take about a dozen prescriptions and pay $250 to $375 a month for medicine out of a monthly income of $1,200. It doesn't leave much room for small indulgences.

"We don't go nowhere. We stay at home," Mr. Pasqua says.

Barbara Berman, director of the Action-in-Maturity (AIM) program for senior citizens in North Baltimore, often sees more serious deprivation among the elderly people she serves as a result of the "ridiculous" prices of prescription drugs.

"They do without or do without food," Ms. Berman says. Sometimes they take desperate measures to make expensive medications last. "They water 'em, they cut 'em in two, they don't take them one day," she says.

It's not just a problem affecting the elderly.

For 34-year-old Barbara Mulder of Essex and 27-year-old Sabrina Eccard of Baltimore, who have epilepsy, the high cost of anti-convulsant drugs meant years of choosing between paying the rent and buying expensive prescription medicines that helped control their seizures. Before they finally got prescription coverage, both women would sometimes stretch out their medication, tampering with the chemical balance that people with epilepsy struggle to maintain.

'Costly process'

Dr. Peter Kaplan, a neurologist at the Francis Scott Key Medical Center in Baltimore, says the practice of stretching out epilepsy medication increases the risk of serious "breakthrough" seizures, which can lead to a trip to the emergency room.

Ironically, the patient who couldn't afford preventive medicine will often be covered for hospitalization. And as the costs are passed along, the bill will find its way to insurance companies, employers, paying hospital patients and taxpayers. "It's a very costly process for the health system as a whole," Dr. Kaplan says.

That's a message the health care task force has heard many times, and members say its proposal will almost certainly include prescription drug coverage as a core benefit in a health plan that would protect every American. But then there's the issue of costs, and that's where the process could turn ugly.

For almost a decade, Sen. David Pryor, the Arkansas Democrat who is chairman of the Senate Special Committee on Aging, has been the industry's "bad cop," holding up to public scrutiny its pricing, profits, marketing practices and tax breaks.

According to a committee staff report released in February, prescription drug prices rose 128.4 percent from 1980 to 1992 -- six times the general rate of inflation and significantly more than any other category of medical care. From 1980 to 1991, according to the committee, the pharmaceutical business led all Fortune 500 industries in profitability, as measured by return on equity.

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