Drug expense can be bitter medicine

Money: Costs continue to rise, hitting seniors particularly hard. Some patients feel a sense of desperation.

April 18, 1999|By Julie Sevrens | Julie Sevrens,Knight Ridder/Tribune

The stories are endless. Elderly wives choosing not to refill their prescriptions because there's barely enough money for their husband's pills. AIDS patients, on their deathbeds, requesting that their unused drugs be donated to individuals who can't afford the $2,000 price.

As the nation's drug costs continue to rise by more than 8 percent per year, the stories become more common, more desperate, louder. And there's no indication they're going to go away.

"If anything, we're going to see more people using more drugs and spending more money on those drugs," says Patricia Neuman, a spokeswoman for the Kaiser Family Foundation, a nonpartisan organization.

Although the average prescription cost was $38.86 in 1998 -- up from $35.72 in 1997 -- some drugs can go for as much as $40,000 a year. Despite a booming economy, a many people are finding themselves unable to afford them.

In 1997, 43.4 million Americans -- or 16 percent of the population -- were without any form of health insurance, according to the U.S. Census Bureau. Medicare, the federal medical plan that covers 39 million Americans -- primarily seniors -- does not provide for prescription medications, except in a very few cases.

U.S. Rep. Tom Allen, D-Maine, has introduced federal legislation that could lower medication costs for seniors. Called the Prescription Drug Fairness for Seniors Act, the bill would allow the elderly to buy prescriptions at the same price HMO members pay.

The pharmaceutical industry, however, has argued that high prices are necessary to cover research and development. While it took an average of eight years to create a new medication in the 1960s, manufacturers now spend about 15 years, carrying out two times the number of safety studies as once was required.

Additionally, only about three in 10 approved drug products recover their costs, according to the Pharmaceutical Research and Manufacturers of America Foundation. Drug makers boost the cost of successful products to cover the cost of failures.

But also driving up drug prices is cost-shifting: Managed-care organizations use their buying clout and their ability to include -- or omit -- drugs from their coverage plans to negotiate savings from manufacturers. Drug makers then charge other groups more to make up for the discounts they provide.

One of the groups thought to be hit the hardest by this phenomenon is uninsured seniors, who typically end up paying double what health maintenance organizations, hospitals and other bulk buyers pay. In the case of the common hormone treatment Synthroid, for instance, seniors have been charged an average of $27.05, or 1,446 percent more than the $1.75 paid by favored group purchasers.

But the public itself is also thought to play a key role in rising drug costs. Since drug makers started advertising new products, patients have been asking their physicians for the medicines by name, even when using the drug isn't their best treatment option.

What you can do

If you need a prescription, odds are you already feel bad. You don't need the high costs of a drug to make you feel worse. There are steps you can take to ease the financial burden:

* Ask your doctor if you can substitute a cheaper, over-the-counter medication or generic drug for your prescription medication. Brand-name drugs cost an average $53.87 per prescription in 1998 compared with the $17.79 equivalent for generic drugs, according to the National Association of Chain Drug Stores.

* If generic drugs are not an option, ask your pharmacist to recommend less expensive brand-name substitutes. Then check with your doctor to see if any of the substitutes are appropriate for you.

* Shop around. Different pharmacies -- even within the same chain -- can charge different prices for the same drug. In a February 1996 survey, New York City's Commissioner of Consumer Affairs found that the price of 20 prescription drugs varied as much as 300 percent in different drugstores in the same city.

* If you have a chronic condition that requires you to take medications over a long period, ask your doctor to prescribe a large quantity. Buying in bulk can cut costs.

* Don't buy more than you need. Find out exactly how long you have to take a prescribed medication and in what dose.

* When you visit a physician, bring along a list of all the medications you are taking. Some medicines conflict with each other, and others are so similar they bring about the same results. Your doctor may be able to reduce the number of your prescriptions.

* Don't stop taking your medications or decrease the number of pills you take just to reduce costs. This could impede your ability to heal, prompting your doctor to put you on even more medications.

* If you have health insurance, contact your plan's pharmacy department and ask for advice on managing the cost of your medication.

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