A newly announced program to give Baltimore residents free discount prescription cards might provide less assistance for some people than other plans do.

Drug discounts' effects vary

April 28, 2005|By M. William Salganik | M. William Salganik,SUN STAFF

Baltimore has an estimated 160,000 uninsured residents - a quarter of the city's population - but it is unclear how many will be helped by a new prescription discount card announced last week by Mayor Martin O'Malley.

Some of the city's uninsured are eligible for programs that provide more help, including state programs with nearly free prescriptions for those with very low incomes, and with deeper discounts for moderate-income elderly.

Others might not be able to afford expensive medications - the average prescription in Maryland costs more than $100 - even with savings of 20 percent or more provided to card-holders.

"If a prescription is $1 and you only have 50 cents, most people would say it's not expensive, but it's twice as much as you have," said David McCaffrey, director of the Center for Pharmaceutical Marketing and Management at the University of Mississippi.

Under the program announced last week, all city residents are eligible for a free discount prescription card that O'Malley said could shave a prescription's cost 20 percent to 50 percent. The city contracted for the card with ScriptSave, a Tucson, Ariz.-based company that issues it at no charge to the city or consumers but charges pharmacies a fee.

"This is not a panacea," said Dr. Peter L. Beilenson, the city's health commissioner. "What we really need to do is drive prices down at the federal level, as other countries do." He added, however, that "it's a nice step to be able to take."

Beilenson said the card - which covers virtually all prescriptions - can even help some insured people. In a few cases, he said, the discounted price might be less than the co-payment of people with insurance. And the card can be used for prescriptions not covered by insurance, including those not on an insurer's list, called a formulary, or "lifestyle drugs."

Most pharmacies offer lower prices to insurers, government programs and others who buy in bulk. Fewer than 10 percent of prescriptions are sold at "list price," generally to the uninsured, according to the National Association of Chain Drug Stores.

"There's no reason uninsured people should pay retail, when you and I, who are fully insured, pay wholesale," said Frances B. Phillips, Beilenson's counterpart in Anne Arundel County.

Anne Arundel is among the few local governments across the country to offer prescription discount programs. It has had a ScriptSave program for five years, limited to residents with low and moderate incomes.

The Anne Arundel program has 3,300 people enrolled, according to Phillips, and collectively they have saved $337,708 since 2001, about 29 percent on the retail price of prescriptions.

The amount of savings varies with the type of drugs. According to the county health department, card savings last month ranged from 13.8 percent on heart medications to 31.6 percent on arthritis drugs, compared with the full retail price.

Anne Arundel, Phillips said, is considering expanding eligibility for its card beyond the low- and moderate-income uninsured.

The cards look good to Rodney W. Jackson, who lives on North Eutaw Street in Baltimore. Jackson said he had health insurance for more than 25 years, but not since he has been unable to work because of medical problems. He said he takes blood pressure, heart, antidepressant and blood thinner prescriptions, which cost him about $190 a month when he can afford them.

"I get some filled," he said. He said he gets samples at health clinics and emergency rooms, and sometimes goes without.

He said he learned of the city program Monday from a health counselor and planned to sign up. His medications would cost about $135 with an average 29 percent discount. That would still be a difficult amount for him to come up with, he said, but the discount would make it more likely that he could get all of his prescriptions filled.

"If your health ain't right, you ain't right," he said. "You got to take care of yourself first."

Although there are no data that show how many people can afford medications at a given discount rate, "we know that cost is a barrier to getting prescriptions filled," said Tricia Neuman, vice president of the Kaiser Family Foundation, which studies the cost and availability of medical care.

A survey by the foundation in 2003 found that 37 percent of the uninsured said they sometimes didn't fill prescriptions or took reduced doses because of cost, compared with 13 percent of those with insurance. (Those with insurance make co-payments that average $40 for drugs not on an insurer's preferred list, and some drugs might not be covered at all.)

The lack of definitive research stems from the recent proliferation of prescription discount cards. The federal Medicare program began approving cards issued by private companies last year.

ScriptSave also has cards sponsored by insurers, employers, labor unions and membership organizations. Some pharmaceutical companies offer their own.

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