Coverage for No One

Coverage for No One

My patient John Elias, with a fixed income from Social Security and a small pension, is a perfect candidate for prescription drug coverage.


My patient John Elias, with a fixed income from Social Security and a small pension, is a perfect candidate for prescription drug coverage. Yet under the new Medicare plan, he is faced with high deductibles, $420 in yearly co-pays and the prospect of $3,600 coming out of his pocket just to receive $1,500 in coverage before a more complete coverage kicks in. But Elias doesn’t take his medicines to begin with, because he doesn’t have the money to buy drugs. When I explain the new plan to him, he simply shakes his head. “Not for me, Doc,” he says.

Elias is paralyzed from the waist down. He suffers from diabetes and hypertension, and he relies on the free samples in my closet to treat these conditions. When I run out of samples, his blood pressure shoots up. His blood sweetens and unsweetens, depending on whether I can offer him his diabetes pill or not. Product samples come in flashy boxes, a few pills per box, designed to lure patients and doctors into using these drugs. Elias swallows the lure, but he wriggles off the hook.

This past fall the New York Public Interest Research Group (NYPIRG) published a survey of 100 pharmacies. It revealed that cash consumers of prescription drugs pay 100 percent more on average for their medicines than the government pays for Army or veteran supplies, and 130 percent more than Canada pays. The problem is that the uninsured and those caught in the gap have no one doing their negotiating for them, no one who can buy in bulk for them. But the new Medicare plan, rather than using that negotiating power to force more reasonable prices, will force the government as well as the poor and those in the gap to pay retail prices for drugs. A large new cohort will be brought to the prescription drug trough, but on drug- company terms.

The new plan will also create a system whereby patients will have to pay top price for drugs they must buy themselves before coverage kicks in again. Joel Eichel, chief pharmacist at Bigelow Pharmacy in New York City, agrees with NYPIRG that cash customers pay the highest prices for their drugs. Eichel cites as an example Lipitor, the cholesterol-lowering drug. The government pays $41.12 for a month’s supply of the 10-milligram tablets. Eichel says that pharmacies pay just under $60 for a month’s supply. But the cash customer pays $85.30. Eichel admits that “cash customers are paying a price so that a retailer can make a profit.”

At the same time, re-imports of the same drugs at a lower price from Canada will be prohibited without FDA approval. The overall result will be to increase drug-company profits while decreasing affordable medications.

The Feds should have looked at New York State’s EPIC plan before imposing a negotiating ban as part of the new coverage. With EPIC, if a Medicare patient is able to show need and an insufficient income, there is only a small out-of-pocket annual fee for medications and a small co-pay; the rest is covered by the state. For those with up to $26,000 in yearly income, the annual fee is only $8 to $300, and co-pays are only $3 to $20 per prescription. New York State, in turn, is responsible for negotiating lower prices with the drug companies for its EPIC members. Elias is not on EPIC because he earns just over $26,000 and so doesn’t qualify for its most affordable program. For those not on EPIC, I am like Robin Hood with my drug samples. The drug reps interrupt me in the hallway on my way to caring for Elias and others. I let them do it, because sometimes my samples are a patient’s only lifeline.

The new Medicare bill will bring the drug companies easy access to a group that can’t afford to underwrite their fancy corporate schemes. Most, like Elias, will simply choose to go without medicine rather than give up their life savings for coverage in name only. For any plan to really work, it must level the playing field. Healthcare, in this case drugs, must be affordable to individuals or the governments that represent them. As things stand, more privatization means more profit, not more healthcare. Only bulk bargaining by the government can drive prices down. The savings in terms of healthcare dollars could then be converted to real drug coverage for those who truly need it. Instead, the new plan ties Medicare’s hands, and may ultimately bring about its downfall, as greedy drug companies draw their profits from the taxpayers and the poor.

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