The top banner on the RxforRI Web site shows a silver-haired couple – exactly the kind of people Americans tend to think of when discussing the high cost of prescription drugs, the tough choices some face between buying food or medicine, and the lure of Canadian imports.
Sure, patients of all ages can have trouble affording drugs, but given that seniors take, on average, twice as many drugs as people under the age of 65, and that they often live on fixed incomes, helping them has long been a priority.
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So RxforRI, a program launched last year that links consumers to more than 150 manufacturer-sponsored programs providing more than 1,200 prescription drugs free or at reduced prices, has been heavily promoted to seniors, as has a national program, the Partnership for Prescription Assistance, launched this spring by the pharmaceutical industry.
Well, that’s about to change.
With the new Medicare Part D prescription drug program starting Jan. 1, the U.S. Department of Health and Human Services this month issued a bulletin warning that when offered to Part D beneficiaries, drug makers’ programs create “a heightened risk of fraud and abuse.”
The idea, not quite explicitly stated, is that a company could provide free doses of its drug during Medicare recipients’ coverage gaps so that, when their coverage kicks back in, they’d continue to get the brand-name drugs, at the federal government’s expense.
If drug makers want to continue to help low-income seniors, HHS suggested, they should consider making cash donations to “bona fide independent charity” programs “that are not affiliated with a manufacturer and operate without regard to donor interests.”
Those who don’t, officials warned, could face sanctions under the federal anti-kickback statute – and in fact, in enforcing that law, HHS will consider whether a company is taking “prompt and meaningful steps” to transition Part D enrollees to “alternative models.”
But in an interview Monday, Ken Johnson, senior vice president of communications for the Pharmaceutical Research and Manufacturers of America (PhRMA), said the HHS warning will instead lead drug makers to stop helping seniors, or at least Part D beneficiaries.
“What they’re saying, in effect, is if we’re going to provide help, we can’t do it through existing patient assistance programs, and that in turn makes it very difficult for our companies,” Johnson said. “We’d have to partner with private foundations, and it sort of defeats the purpose of what we’re trying to do. Most of our companies already have their own foundations that provide free or nearly free drugs.”
More than 43 million Americans are eligible for Medicare prescription drug coverage, federal officials have said, but far fewer are expected to enroll; one recent poll found only one in five Medicare beneficiaries planned to sign up, and one in three had decided not to.
Seniors counting on patient assistance programs, however, may find they’re ineligible even if they stay away from Part D. Given the legal risks, Johnson said, some drug companies are going to exclude seniors – though there are exceptions, such as Bristol-Myers Squibb, which has said it’ll continue to help seniors who don’t sign up for Part D.
With such a core constituency gone, though, will the programs survive?
Definitely, Johnson said. In fact, less than 30 percent of the people served by those programs now are Medicare-eligible, he said. So as seniors transition into Medicare Part D plans, the drug makers’ programs will simply shift their focus to younger people.
“What we’re seeing is a growing number of uninsured Americans across the country who are under 65, and that is troubling to us,” Johnson said. “We’re going to be doubling our efforts in the next year to help them. There are an estimated 29 million people who potentially could qualify for assistance and are under age 65. We’re going to be going state by state, city by city, trying to help those people.”
So just as this spring, PhRMA sent out a “Help Is Here Express” bus tour to promote the Partnership for Prescription Assistance, another tour will be launched soon targeting younger audiences. And to reach those younger people, the program has enlisted a new celebrity spokesperson: TV talk show host Montel Williams.
“We’re committed to signing up millions of people across the country in the next year,” Johnson said. “We recognize that if we’re going to continue to have a free-market system that respects the need for innovation and the need for research and development, we have to make certain that people don’t fall through the cracks, and right now, millions of people are.”
“So it’s not only the right thing to do,” Johnson added; “it’s also the smart thing to do from the business standpoint.”
