Helping Low-Income Patients Obtain Prescription Medications FREE

The cost of prescription medications continues to rise, and many older Americans do not have insurance coverage for medication costs. Spending for outpatient prescription drugs in retail outlets in the United States rose 17.1% from 2000 to 2001, from $131.9 billion to $154.5 billion, while the average cost of a prescription drug rose 10.1%.¹ In 1997, only 56% of Medicare beneficiaries had some prescription drug coverage, while the remainder had no coverage for outpatient drug expenditures.² Older Americans may be forced to choose between paying for essential medications or food.³ A November 2001 Harris Poll of 1100 adults found that 22% of those surveyed had not filled at least 1 prescription for medications during the year to save money.⁴ The problem is even greater in households with lower incomes. In households with incomes less than $25 000, 40% did not fill at least 1 prescription, and 30% took prescription medications less often than prescribed to save money.⁴ Along with multiple medications for hypertension, diabetes, or other systemic illnesses, ophthalmology patients often require long-term medications for the treatment of glaucoma, uveitis, or dry eye. The average wholesale cost in the United States of Timoptic 0.5% (Merck & Co, Inc, West Point, Pa) (5 mL) is $20.44, Xalatan 0.005% (Pharmacia Corporation, Phoenix, Ariz) (2.5 mL) is $45.03, and HypoTears (CIBA, Duluth, Ga) (15 mL) is $8.27.⁵ Ophthalmology patients may unfortunately view expensive sight-saving medications as nonessential, especially when prioritizing the many systemic medications they require each month.

There are ways ophthalmologists may help their uninsured or low-income Medicare recipient patients to obtain medications at no cost directly from the pharmaceutical manufacturers. Virtually all drug manufacturers offer programs to provide free medications for those who have no prescription drug coverage and whose income falls below certain levels, regardless of age. These programs are not widely publicized, and many ophthalmologists may be unaware of the programs. There are several ways to obtain information regarding these programs. The American Academy of Ophthalmology (San Francisco, Calif) publishes the Directory of Ophthalmic Pharmaceutical Assistance Programs for the Medically Underserved. This directory was created by the Foundation of the American Academy of Ophthalmology's EyeCare America program. This guide is free to ophthalmologists and provides an alphabetical list of ophthalmic medications and the manufacturer of each medication. The manufacturers are subsequently listed with information regarding the assistance programs of each manufacturer.

Harsonhill (Woodland Hills, Calif), a prescription information publishing company, provides a patient-oriented listing of pharmaceutical manufacturers' assistance programs for the needy. This guide also includes a financial status affidavitand a physician assistance form that may facilitate providing the appropriate information to the drug assistance programs.

Pharmaceutical Research and Manufacturers of America (PhRMA) (Washington, DC) also provides a list of manufacturers' advertised patient assistance programs free of charge. This is the same list provided by Harsonhill but does not provide a reference medication listing to help guide the physician and patient to identify the manufacturer. (See the "Resources" box.)

A brief survey of several manufacturers' patient assistance programs reveals that these programs are currently being used by many who are aware of the programs. Alcon Laboratories (Fort Worth, Tex) (including Falcon) provided assistance to approximately 18 000 patients in 2001 through their Glaucoma Patient Assistance Program, while approximately 1500 patients received assistance through the patient support program of Novartis Ophthalmics (Duluth, Tex). Merck & Co, Inc, could not provide a break-down of ophthalmic medications alone, but more than 350 000 patients receive assistance through the Merck Patient Assistance Program.

Patients must apply separately to each company for each medication and reapplication is typically required every 3 months. Patients may need to provide proof of financial status such as a tax return or notarized affidavit of financial need. Drugs are dispensed through the physician, and the physician must fill out applications on behalf of the patient. This paperwork may be burdensome but ultimately, as the patient's advocate, the physician may be able to ensure that patients will receive sight-saving medications and avoid a potential decision between paying for food or paying for prescriptions.

Corresponding author: Justin L. Gottlieb, MD, 2870 University Ave, Suite 206, Madison, WI 53705 (e-mail: jlgottlieb@facstaff.wisc.edu).

The following organizations provide directories and guides for patient assistance programs.