Avoiding an Rx for Disaster: Prescription Drug Options for the Uninsured

The rising costs of prescription drugs combined with a lack of drug coverage are leaving consumers without the medication they need. Fortunately, assistance may be available.

The results of a national study performed nearly 5 years ago indicated that 14% of the U.S. population lacked any type of health insurance whatsoever. Even more startling: a staggering 25%, almost double that, did not have insurance covering prescription drugs.[1] As drug prices continue to climb, those figures are sharply increasing.

According to the AFL-CIO Task Force on Prescription Drugs, there are three factors that contribute to the rapid increase in prescription drug expenditures:

a.) the growing number of prescriptions per person;
b.) the availability of newer, more expensive drugs that replace older, less expensive medicines; and
c.) the price increases of existing drugs.

In response, states have tried to control escalating costs by limiting the utilization of prescription drugs, pressuring drug companies for price concessions, and changing the Medicaid payment formula. It is estimated that overall spending by and for Medicaid beneficiaries will more than triple over the next decade, from $71 billion in 2001 to $228 billion in 2011.[2]

Treatments for various conditions and diseases can put strain on both a patient’s pocketbook and psyche. To compound the problem further, many are on fixed incomes, with no prescription drug insurance and limited “disposable” income which can be designated for healthcare costs. Even those with insurance coverage know they have no guarantees: many have had to meet skyrocketing deductibles and had prescriptions go partially paid for – or totally uncovered. Fortunately, there are loopholes in every healthcare roadblock. If lack of coverage is a prescription for disaster, the following options may be the cure:

Dispense as Written?
While all drug costs are rapidly increasing, the cost of brand name medicines is increasing even more quickly. Are you eligible for the generic version of your prescription, or must you have the brand name? Ask your doctor and pharmacist if your prescriptions can be filled with the lower-cost generics. In some instances, this is not possible because the brand names are more efficacious than their generic counterparts. More: United States Food & Drug Administration Office of Generic Drugs – http://www.fda.gov/cder/ogd

Going to the Source for Assistance:
Going directly to the drug manufacturer can be most helpful in obtaining low or no cost prescriptions. Contact the company and ask about their Prescription Assistance Plan. Almost all drug companies offer such programs, which enable consumers to receive drugs they need at a price they can afford (often for free). A lengthy application co-signed by your physician is typically necessary for entry into the program. More: The Partnership for Prescription Assistance – https://www.pparx.org/Intro.php

When in Doubt, Ask About…
…Samples. Many physicians will assist their patients by providing free samples of the prescription. Ask your doctor. More: Medicine For People in Need (MedPin) – http://www.medpin.org/freedrugs/drug_samples.html

Ask Your Accountant:
Ask your tax advisor if you can claim any out-of-pocket healthcare expenses. Refer to Internal Revenue Service Pronouncement Rev. Rul. 2004-38 (IRB 2004-15).

Go on “Trial:”
Clinical trials are an excellent way to receive (often groundbreaking) treatment for various medical conditions. Occasionally, trial participants will also receive financial reimbursement for their participation. Medication used in the trial is free, as is the healthcare provided throughout the course of the study. Talk to your doctor about clinical trials she or he may be participating in, or visit http://www.centerwatch.com for information on current trials you might be eligible for.

Too Sick to Work? Your Insurance Still has to Work for You:
If you have been fired or left your job, a Federal law protects you from losing your insurance. Known as COBRA [Consolidated Omnibus Budget Reconciliation Act], your employer must allow you to keep your policy for up to 18 months after you’ve left the company. This option, while expensive, ensures that you will not be left without any coverage at all. Certain criteria applies, such as number of employees at a company and length of time within a job. More: United States Department of Labor COBRA information site – http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html

Government Assistance:
There are different Federal programs which can provide patients with assistance. Be prepared for a lengthy application process, but once approved, you can receive coverage that will help. Ask your local health services office about MediCare, MedicAid and Social Security Disability Insurance. More: Official U.S. Government Site for Medicare – http://www.medicare.gov/

Be organized and plan out options to manage your rising healthcare costs, whether through insurance coverage, local or Federal assistance, healthcare spending accounts, or other approaches. Check out http://www.disabilityresources.org/RX.html for further information and various links to Prescription Drug Assistance programs.

References:

1, 2 – 06/17/02 Testimony Presented by the Fiscal Policy Institute to the New York State AFL-CIO Task Force on Prescription Drugs: “Escalating Prescription Drug Costs – The Reality and Options for Reform.” Available online: http://www.fiscalpolicy.org/Prescription%20Drug%20Testimony.pdf. Last accessed July 3, 2005.

* Newsbatch Guide to Policy Issues: http://www.newsbatch.com/hc-gdprise1.html
** http://news8austin.com/content/legislature_2005/stories/?ArID=139146&SecID=480

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