The Problem:Rising drug costs
Causes of increased costs
Challenges for the uninsured and underinsured
Challenges for the insured
Existing Efforts:Local, state and national
Federal and industry initiatives
Kentuckys overall approach
Assistance in the Owensboro area
Possible Solutions:A local approach
Community-based health programs
Local pharmacy programs for the poor
Centralized processing center
Key Health Care Initiatives
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These statements represent the findings of a study commissioned by the Public Life Foundation of Owensboro to explore the issue of prescription drug costs and ways to address the growing problem on the community level.
The study documents the many ways in which Daviess County citizens, and charitable and private organizations assist in this critical area. But the absence of coordination of these efforts leaves gaps in the local safety net for the poor and results in more work for those trying to help.
A positive reality, however, is that the presence of both volunteer and professional service providers gives Daviess County a solid foundation upon which to build an effective local strategy. The county government is already taking steps in this direction by exploring the possibility of a community-based health care model, and through cooperative efforts such as the recent commitment of Owensboro Mercy Health System to pay for a physician to serve the communitys two free clinics. As local leaders explore even more ways to help citizens cope with the high costs of prescription drugs, there are models in place elsewhere that could be replicated here. They range from programs that offer comprehensive services at no or reduced cost to those that streamline the process of using drug-manufacturer programs to obtain free medicines for the poor.
And the results of community-based initiatives often mean reduced costs for patients as well as the overall health-care system.
The challenges facing Daviess County reflect those of the state and nation:
The problems facing uninsured or underinsured patients are particularly challenging.
Many state governments and the federal government have explored ways to provide free or low-cost medications to the uninsured and to Medicare recipients who do not have supplemental drug coverage. But the slowing economy makes it unlikely that a federal program will be enacted in the near future, and Kentucky has taken a fragmented approach to addressing the issue.
Initiatives in other states include:
The magnitude of the problem can make it difficult to envision a local solution, and much of it needs to be resolved at the national level. Still, experts believe and experience in other communities shows that much can be accomplished through community-based initiatives:
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Prescription drug costs are accelerating at an alarming pace in Owensboro and across Kentucky and the nation. Locally, paying for prescriptions emerged as a top concern of the hundreds of citizens who participated in forums held by the Public Life Foundation during 2001.
The foundation commissioned this report to help Daviess Countians make informed decisions about how best to cope with these costs and concerns. The report is based on a review of recent studies and other literature at the state and national levels; interviews with health care professionals, government officials and social services providers in Owensboro and elsewhere in Kentucky; and surveys of drug costs and prescription-assistance programs in the Owensboro area.
At pharmacies in Owensboro and around the country, patients are paying more than $100 for a 30-day supply of the anti-ulcer drug Prilosec three and a half times more than they would be charged for similar drugs that are available as generics.
Despite the higher cost, many doctors and patients prefer Prilosec. It may be more effective for some gastrointestinal problems and has racked up the sales to prove it. Newer, brand-name drugs such as Prilosec fueled a 19 percent increase in spending on prescriptions between 1999 and 2000.
But high and rising drug prices, however dramatic, are not the most significant factor accounting for escalating prescription costs. That designation, by all accounts, belongs to the volume of prescriptions being written. In 1992, the average American filled seven prescriptions. In 2000, the average was almost 11.
And Kentuckians take even more prescription drugs an average of 14.3 per person, the second highest number per capita in the country, according to the Kaiser Family Foundation State Health Facts Online report. There are several theories about why this is so the fact that there are more children in poverty, and on Medicaid, in Kentucky; the prevalence of poor health in parts of the state; liberal prescribing in some regions where managed care companies arent trying to rein in costs.
But in general, rising demand for new drugs is driving the increase in prescriptions. Evidence of this is found in Kentuckys Medicaid program, which pays for health care for low-income families with children and some needy adults. Kentucky Medicaid, according to media accounts, spent more for the three most popular antacids, including Prilosec, than it did on dental care in fiscal 2001. Nationally, Medicaid spending on prescription drugs more than tripled between 1990 and 1999.
Such strong demand allows drugmakers to sustain relatively high prices. Last year the top-selling (and mostly newer) 50 drugs cost an average of $76 a month, double the cost of the rest, research shows.
What is causing drug costs to rise?
Health care is changing. To reduce overall costs, the nations health-care system has been shifting from inpatient care to outpatient care since the 1970s. This has meant fewer hospital stays and more home-based care and convalescence. As a result, virtually all employer health-insurance plans now cover prescriptions for outpatients but only for people younger than retirement age.
THE DRUG INDUSTRY: PRO AND CON
Are drugmakers justified in selling drugs at high prices because of the risks they take developing the drugs and the benefits for consumers? Or are they taking advantage of government and consumers to make a profit? There are strong advocates on both sides. Here are some of their arguments, pro and con:
New drug prices are high because manufacturers spend a lot on research to develop the drugs.
The drug industry does invest millions in research and development, and that investment has more than tripled since 1990.
However, the industry also benefits heavily from taxpayer-funded research. According to The New York Times, a 1995 Massachusetts Institute of Technology study found that, of the 14 new drugs the industry identified as the most medically significant in the preceding 25 years, 11 had roots in studies paid for by the U.S. government.
Likewise, a 1997 study commissioned by the National Science Foundation found that only 17 percent of the most significant scientific research papers cited in medicine patents came from the drug industry.
Still, those R&D costs eat up profits.
But Fortune 500 rankings released in April 2001 showed that the drug industry is the most profitable in the country, a status it has held for many years:
The drug industry also has to cope with generics taking away their market share.
Generics do diminish market share probably half or more of a brand-name drugs sales. Generics also have increased their own market share since 1991, and are now holding steady at about 42 percent. More insurance plans are offering financial incentives for doctors and consumers to use them in place of brand-name drugs when available. But generics arent able to compete with a brand-name drug until its 17 years of patent protection has expired.
Meanwhile, drug companies are moving new products to market much faster:
Some drug companies also have tried to delay the emergence of generic alternatives onto the market. Recently Congress considered legislation to force the companies to disclose agreements with generic manufacturers to delay cheaper treatments, according to CongressDaily. Drug companies also effectively delay generics by challenging them in court; in some cases, they also have ownership interests in their generic competitors.
Some 18 percent of Daviess Countians cannot afford to pay for their prescription medications, according to the University of Kentucky Health Needs Assessment conducted last year. And this number may be rising.
Although several local agencies and providers try to help the uninsured get free prescriptions from drug manufacturers, the manufacturer programs limit supplies and do not offer a permanent solution for those with chronic conditions.
At the same time, there are many underinsured people in Daviess County, including those on Medicare. Nationally, more than a third of the Medicare population doesnt have supplemental drug coverage, according to the AARP.
Perception: Most poor people and old people get some kind of prescription-drug assistance from the government or charity.
Reality: No they dont. Medicaid covers only poor families with children and other adults with certain disabilities. Many low-income adults are not covered. Also, Medicare generally does not cover the cost of medication for the elderly except for drugs administered in the hospital. And, unlike most other states, Kentucky does not offer a discount drug program for the elderly.
Charities try to help and do but their funding sources are limited and they cant always serve everyone. At the Free Clinic in Owensboro, for instance, low-income working people can get prescriptions, but there are so many more people who need help with their medicines than just these, says clinic director Cleona Durham. There are people on disability who really, really need it, but they dont qualify to come to us, and the same is true for people on Medicare, she said.
Some of the most substantial help for the poor, in fact, comes from the drug companies themselves, which supply free drugs for limited periods to patients who meet financial guidelines.
is likely that advertising does influence volume growth, a more salient
question to answer is whether or not that growth is appropriate.
If patients, for example, with milder and non-suicidal depression feel
better on medication, or if more expensive but less sedating antihistamines
improve concentration, are these gains worth the extra costs? If they
are, should the patient, the health plan, the employer or society pay
for these improvements?
The low-income elderly are particularly hard hit: A study by the RAND Corp. shows that their financial burden for prescription drugs is three times higher than that of middle-income seniors and 10 times higher than high-income seniors. Chronic conditions also more than double the burden, the study found.
People without insurance to cover their prescription drugs have no collective purchasing power. That makes it even harder for them to afford the medicine they need.
As a national average, these people spend 15 percent more per prescription than insurance companies do because insurers and government purchasers negotiate volume discounts. One comparison by the U.S. Department of Health and Human Services estimated that, for the same drug, government programs would pay $24 per prescription, insurers would pay $30 to $44, and the uninsured would pay $52, the full cash price after wholesaler and pharmacy markups.
Among the disadvantages for the uninsured:
The following chart demonstrates that Medicare beneficiaries with drug coverage spend less out of pocket than those without drug coverage. At the same time, the total spending of those with drug coverage is higher they can afford more prescriptions because their insurance pays part of the cost.
Income as percent of poverty
avg. total spending
|Up to 135 percent of poverty||
|136-150 percent of poverty||
|151-175 percent of poverty||
|176-200 percent of poverty||
|201-300 percent of poverty||
|301-400 percent of poverty||
|Above 400 percent||
Source: U.S. Health and Human Services "Report to the President: Prescription Drug Coverage, Spending, Utilization, and Prices," April 2000.
The 20 percent of Daviess Countians who report they cannot afford prescription drugs considerably exceeds the nine percent who have no health insurance. This is clear evidence that the high costs affect a broad segment of the population.
Insurance costs themselves present another challenge: They are higher in Daviess County than in many other parts of Kentucky. And as drug costs force insurance premiums even higher, more people are at risk of being unable to afford basic coverage.
According to state Insurance Commissioner Janie Miller, insurance companies say that doctors and hospitals in Owensboro and other parts of Western Kentucky arent interested in taking part in their managed-care plans. The doctors and hospitals, meanwhile, typically argue that insurance companies are not offering to compensate them fairly, she said.
Daviess County did try to make affordable insurance available through a community-sponsored HMO, MedQuest, which was created in 1996. However MedQuests low-cost policies lost money and the program went under after raising rates and losing customers as a result in 1999.
It is unclear how or whether insurance coverage and costs affect the cost of health care and prescriptions locally, but certain distinctions about Daviess County are worth noting:
Perception: Working people have to pay more of their own health-care costs than they used to.
Reality: Actually employers have been picking up more of the cost of health coverage and prescription costs in the last several years, in part because of the booming economy and labor shortage:
Perception: Insurance premiums are going up because insurance companies cannot afford to cover all these prescription drugs.
Reality: To be sure, the cost of prescription drugs is rising for insurance firms by as much as 20 percent per year. But prescription drugs account for only a small portion of overall health care spending about 8.5 percent, according to Tufts University researchers. By comparison, hospital spending accounts for a third of the total cost of health care.
Thus it may be that other health-care costs are driving premium increases as much or more than prescriptions. In the fall issue of Health Affairs, J.D. Kleinke of the Health Strategies Network cites the Tufts research in arguing that even a 20 percent annual increase in a care component that represents only 8.5 percent of all spending (for insurers) does not explain premium increases of the same magnitude.
In Kentucky, for instance, the cost of state employees prescription drugs increased by 17 percent between 1999 and 2000. But the states spending on prescriptions as a percentage of overall medical care grew only one percent, from 18.1 percent to 19.1 percent.
A survey of Medicare
supplement providers in the Owensboro area found the cheapest premium
for a supplement with drug coverage, offered by AARP, was $132 per month.
This covers half of outpatient drug costs after a yearly deductible
of $250 and up to a maximum benefit
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Nationally, government and industry are looking for ways to help the uninsured and underinsured as well as to cut or shift costs for prescription drugs.
These efforts dont always complement each other. For instance, the federal government is considering offering drug coverage to Medicare recipients.
At the same time, some private insurers are already getting out of the business of offering Medicare HMOs which offer drug coverage, and supplemental Medigap policies have become more expensive.
Early in 2001, state governments tried to step into the breach by improving or adding discount drug programs for the elderly and the poor. More recently, however, they have been looking for ways to trim budgets in the face of lower-than-expected tax revenues and higher prescription-drug costs for state employees and Medicaid recipients.
In the private sector, meanwhile, insurers are raising the premiums that employers pay for their health plans, and employers are passing those costs along to employees.
A few examples:
Illinois created a drug benefit for seniors who are ineligible for Medicaid and lack private insurance coverage.
Perception: Requiring people to pay more of the cost of their drugs may keep them from spending so much on medicine that is unnecessary or too expensive.
Reality: It may well do that. But it may also increase health-care costs overall because higher prices for drugs discourage some people from taking the medications they need to stay out of the hospital.
According to a report in the January 2001 Journal of the American Medical Association, elderly people and welfare recipients who cut back on their use of essential drugs after more of the cost of the drugs was shifted to them doubled their rates of serious adverse events and emergency-department visits associated with these reductions.
Says a report by Merck-Medco, the pharmacy benefits manager, When the cost-share increases exceed 10 percent the utilization of essential medications for chronic conditions such as hypertension and diabetes is reduced, which could lead to higher health care costs and negative outcomes.
At the same time, community programs which have provided free medical care and prescriptions to the elderly and poor, including Project Access in Asheville, N.C., and SkyCAP in Eastern Kentucky, have recorded dramatic decreases in the costs of hospital and emergency-room care for their clients.
Congress last year considered spending up to $300 billion on a drug benefit for seniors over 10 years, according to media reports. At best, such a plan would have required seniors to pay about $53 a month in premiums and would cover only half the cost of each prescription until a persons out-of-pocket costs reached $3,500.
Insurers and employers are also changing the structure of their drug benefits so employees pay more for brand-name drugs. These are known as tiered drug plans. Generic drugs and those on an insurers approved list or formulary cost less than brand-name and non-formulary drugs. According to pharmaceutical-benefits manager Merck-Medco, nearly half of all HMO enrollees will have a three-tiered drug plan by the end of 2001. Some companies are also considering four- and five-tier plans.
In addition, Humana and other insurers are responding to rising costs by experimenting with defined contribution plans that give employees a set amount of money to spend on insurance for the benefits they prefer rather than providing the same benefits to all.
As an employer and provider of Medicaid services, Kentucky has taken steps to pass along costs to employees and limit access to the most expensive drugs for the poor. However Kentucky has not yet joined other states in purchasing cooperatives to reduce costs, nor has it offered a discount program for low-income seniors as have most other states.
The state has supported a private nonprofit effort to help provide prescription drugs to the states poorest citizens. However, that program, Health Kentucky, is not an option for anyone with insurance, which would include Medicare recipients without drug coverage. There are other efforts around Kentucky to deal with the issue on a regional or community basis, but those efforts are limited in scope and independent of each other.
Efforts in Kentucky
Following is a list of some of the pharmaceutical assistance programs around the state.
Health Kentucky, Inc., Kentucky Physicians Care Pharmaceutical Assistance Program serves uninsured residents with incomes below 100 percent of the federal poverty level.
Medication is provided free through donations from drugmakers. The state Department of Social Insurance determines eligibility. Patients go to participating doctors, who write prescriptions that patients take to participating pharmacies.
Pharmacies report the prescription to Health Kentucky, which reports it to drugmakers, which reimburse the pharmacies with medication. The drugs provided include only what Health Kentucky has negotiated for free from the drugmakers, which means that while patients can get some common (erythromycin) and/or expensive drugs (Celebrex, Lipitor), they are also eligible for so-called lifestyle drugs such as Retin-A and Viagra.
Kentucky Free Health Clinic Association reports there are at least 29 free clinics across the state, primarily in far western, far eastern and central Kentucky. Among other things they help clients apply for free prescriptions from drugmakers and Health Kentucky and dispense free drug samples provided by physicians who work with them; some clinics purchase medication for patients if its not otherwise available. Still others, such as St. Lukes in Hopkinsville, work directly with pharmacists. Charitable contributions from the community support the bulk purchase of medications.
American Medical Pharmaceutical Outlet, Shelbyville connects low-income people (generally individuals earning less than $16,000 and households earning less than $25,000 with no insurance) with free drugmaker programs. The cost is a onetime $20 registration fee plus a $10 processing fee for each application. It usually takes 10 to 12 weeks after submitting a form to get medication in supplies that last up to 90 days.
Foundation for a Healthy Kentucky provides no direct assistance but does research and recommends solutions to health-care problems; it is funding endowed chairs at the universities of Louisville and Kentucky in urban and rural health-care policy, respectively. The foundation may look at prescription-drug costs, according to chairman Laurel True. The foundation is funded with $45 million from the 1999 settlement of a state lawsuit against Anthem Insurance; it will have $2 million per year to spend on projects.
Kentucky Homeplace, which serves Eastern, South Central and far Western
Kentucky, uses lay workers from low-income clients communities to
help them get needed care, including prescriptions. Over the years it
has provided clients with $1 million in free prescription drugs. The program
is funded by the state of Kentucky and is administered by the University
of Kentucky Center for Rural Health in Hazard.
Faith Pharmacy. Faith Pharmacy in Lexington, a mission of Maxwell Street Presbyterian Church and Christ the King Cathedral, depends on samples from pharmaceutical companies. Drugs not available in sample format are purchased with funds from private and corporate donations. The pharmacy, which is open on Saturday mornings, is operated solely by volunteers. Patients must be referred by churches, doctors, nurse practitioners or recognized social service agencies. The referral verifies that the patient does not have health insurance or cannot afford his or her medications at the current time. While the patient is waiting, volunteers fill out drug assistance program forms.
Caritas Health Services medicine bank program in Louisville. The nonprofit hospital provides about $100,000 a year to help people pay for medicines to meet short-term needs. The program is administered by four community ministries in southern Louisville and Jefferson County. In addition to buying medications with the Caritas funding, the program links people to other programs that provide free drugs.
Association of Clinicians for the Underserved. This national organization, based in Lexington, publishes information about how to provide prescription drugs and other forms of medical care to the uninsured and underinsured.
Many agencies and health care providers in the Owensboro area have their own programs to help the poor get prescription drugs. However there is little or no coordination of these efforts, which typically are independent of each other.
In interviews for this report, leaders of some of these efforts did not know about others that might offer additional assistance to the population they serve. In addition, many of the local programs depend on free prescriptions from drug manufacturers, which provide a temporary supply of brand-name drugs that are costly for those with chronic conditions to continue.
Among the efforts taking place locally:
Many patients receive help from their doctors offices to fill out drugmakers forms for free medications, and area churches and other organizations may be solicited to pay for prescriptions for low-income patients. In addition:
Every day I come to work and wonder whos going to hit me with $1,000 worth of prescriptions that day, and Im going to have to look at them and say, Ill try.
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Some of the problems of prescription drug spending drug pricing by manufacturers, premium hikes by insurers, regulatory policies set by the FDA seem all but insoluble for local citizens and communities. Although it is certainly possible to advocate for changes in those areas, there is little to be done directly:
"The local level has the last advantage in addressing this kind of issue because there is power in numbers," said Julia Costich, a health-care policy researcher at the University of Kentucky. "Trying to solve or even address this issue on a community-specific basis really is a struggle. At bottom, this is a problem that needs to be resolved nationally, at a federal level."
Yet Costich actually encourages local initiatives, describing them as "the only tools we have." Others in Kentucky point out that, while rising drug costs are a national problem, they affect individual communities differently. Local people can better assess their own situations than someone from far off, said Judy Jones, director of the Kentucky State Office of Rural Health. And while academics and others can offer guiding principles, exactly how those are applied is best understood by local people, Jones said.
Deciding Who to Help
One of the first tasks for any community looking to help its population with health costs or prescription drugs is deciding who needs help the most, and where to draw the line for assistance.
Should efforts target the uninsured? The elderly? Those with chronic conditions? Most communities try to take on the neediest cases, simply because resources are limited. Fortunately, children from poor families in Kentucky and Daviess County receive assistance through Medicaid, the Kentucky Childrens Health Insurance program and free care from local providers, noted local pediatrician Don Neel.
Otherwise, I think its going to be a matter of helping those who cant afford it, he said. Thats a big group. In addition to uninsured adults, it could include local Medicare recipients without drug coverage, rural residents with transportation problems and small employers who cannot afford insurance for themselves, much less their employees.
Other communities, including some in Kentucky, have found that by coordinating services and sharing the load of health care for the needy, they can ease the burden on the uninsured as well as on local providers.
These programs typically require that all stakeholders from consumers to doctors to social-service providers have input into both planning and implementation. Some of these programs are funded with help from local, state or federal governments; others depend in part on grant awards. In general these programs are expected to become self-sufficient with a local source of funds within a few years.
Some local organizations might be able to tap into the federal governments
programs to provide discounted drugs to those who need them.
The U.S. government offers two ways for certain local clinics and hospitals
to provide discounted drugs to patients the 340B Drug Pricing Program
and the Prime Vendor Program.
The programs allow qualified clinics and hospitals to buy certain prescription drugs at a discount, offering patients savings of 25 to 50 percent. In addition, they may work with a prime vendor or wholesaler who can provide some drugs at a further discount. The federal government also has a pharmacy demonstration project which provides funding for communities that want to develop low-cost medication programs.
Organizations in Owensboro such as the Green River Health Department may be eligible to take advantage of these programs (the only eligible hospitals in Kentucky are those at the universities of Kentucky and Louisville). The programs are generally limited to agencies that get federal funding to provide services to the indigent or to specific classes of patients such as migrant workers or those with AIDS. Discounted prescriptions can be distributed through on-site or contract pharmacies.
A centralized processing center could give local providers and health agencies relief from time-consuming administrative chores.
Part of the problem with prescription-drug assistance in Daviess County is that providers and organizations are often unaware of whats available locally. At the same time, those who provide services have lots of paperwork to complete, particularly for the drugmaker programs for the indigent. Each manufacturer has a different form and different requirements, and physicians must sign the forms for the drugs to be delivered. Delivery time also takes several weeks, and patients may need medications in the meantime.
There are national efforts under way to convince the drugmakers to develop a common application form, but using drugmaker programs will still require coordination. There also are many other local efforts to help the needy including discount cards now being offered by various drug companies and organizations.
This is why the notion of a processing center has gained ground among some of the organizations that provide these services.
There needs to be, particularly for the elderly, a point of entry that a person can go to and be directed into whatever service or provider that person needs, said Lamone Mayfield, director of the Green River District Health Department.
Noted Brenda Clayton, executive director of the Ohio Valley Physicians Association who formerly helped coordinate the drugmaker assistance program at Green River Heart Institute, None of its impossible. Its just going to be a coordinating job."
More information about drug prices could help consumers and their doctors explore less expensive therapies or medications.
Because many elderly people on Medicare, as well as the uninsured, must pay full price for drugs, it is important that they find the lowest-priced prescriptions.
The chart shows that prices for a months supply of medication can vary widely among drugstores, and there is not a clear distinction between the prices at independent and chain pharmacies. It also shows that the generic version of a drug can be much cheaper than the brand version.
|Danhauer Drugs (ind)||
|Nations Medicines (ind)||
|Mills Drugstore (ind)||
$54.09/$18 or $19
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Access Project, www.accessproject.org.
Employer Health Benefits 2000 Annual Survey, Kaiser Family Foundation, 2000.
Express Scripts 2000 Drug Trend Report, Express Scripts, June 2001.
First Health Community Voices, www.communityvoices.org.
FYI: The Cost of Prescription Drugs: Who Needs Help?, AARP Public Policy Institute, October 2000.
Green River Area Development District Health Needs Assessment, University of Kentucky, 2000.
How Much are Medicare Beneficiaries Paying Out-of-Pocket for Prescription Drugs?, AARP Public Policy Institute, September 1999.
The Implications of Medicare Prescription Drug Proposals for Employers and Retirees, Hewitt Associates LLC, July 2000.
Medicaid and the Uninsured: The Role of Medicaid in State Budgets, Kaiser Family Foundation, October 2001.
Medicare and Prescription Drug Focus Groups, Summary Report, Public Opinion Strategies and Peter D. Hart Research Associates, July 2001.
Merck-Medco 2001 Drug Trend Report, Merck-Medco, 2001.
Notes, Citizen Forum, Peoples Health Project, Public Life Foundation of Owensboro (Ky.), 2001.
Owensboro-Daviess County Health Needs 2000 Report, University of Kentucky, 2000.
Pharmaceutical Marketplace Dynamics: Expenditures, Distribution, Coverage Pricing, John M. Coster, Ph.D., R.Ph., National Association of Chain Drug Stores, presentation for National Health Policy Forum, May 2000.
Prescription Drug Benefits: Cost Management Issues for Medicare, AARP Public Policy Institute, August 2000.
Prescription Drug Coverage for Seniors, Kentucky Long-Term Policy Research Center, August 2001. http://www.kltprc.net/policynotes/Chpt_6.htm
Prescription Drug Expenditures in 2000: The Upward Trend Continues, National Institute for Health Care Management, May 2001.
Prescription Drug Trends: A Chartbook, Kaiser Family Foundation, July 2000.
Public Employee Health Insurance Information, (booklet), Office of Public Employee Health Insurance, Kentucky Personnel Cabinet, 2001.
Public Employee Health Insurance Information Plan Year 2000, (report) Office of Public Employee Health Insurance, Kentucky Personnel Cabinet, and William M. Mercer, Inc., October 2001.
Recent Trends in Prescription Drug Spending for Insured Individuals Under 65 and Age 65 and Older, RxHealthValue, July 2001. www.rxhealthvalue.com
RX R&D Myths: The Case Against the Drug Industrys R&D Scare Card, Public Citizen, July 2001.
Targeting Medicare Drug Benefits: Cost and Issues, Marilyn Moon, et al, Kaiser Family Foundation, May 2001.
The Value of Innovation, Health Affairs, September/October 2001.
Volunteers in Health Care, www.volunteersinhealthcare.org and www.volunteersinhealthcare.org/Reports/ RX.htm .
What Next for Kentucky Health Care?, Michal Smith-Mello, Julia Field Costich and F. Douglas Scutchfield, Kentucky Long-Term Policy Research Center, 1999.
Why Do Medicines Cost So Much?, Pharmaceutical Research and Manufacturers of America (PhRMA), June 2000. www.phrma.org
Numerous individual articles from newspapers, including The New York Times, The Courier-Journal, the Lexington Herald-Leader and The Owensboro Messenger-Inquirer, and periodicals, including the Journal of the American Medical Association and the Annals of Internal Medicine.
Earl Adams, insurance representative
Mary Anderlik, University of Louisville
Greg Carlson, Owensboro Mercy Health System
Brenda Clayton, Ohio Valley Physicians Association
Julia Costich, University of Kentucky
Linda Dant, McAuley Clinic
Cleona Durham, Free Clinic
Fran Feltner, SKYCAP, Hazard, Ky.
Dana Froehlich, Green River Area Development District
Bob Gray, Kentucky Attorney Generals office
Pat Green, Commonwealth Aluminum
Reid Haire, Daviess County Judge-Executive
Bob Hood, St. Vincent DePaul Society
Clifford Hynniman, University of Kentucky College of Pharmacy
Judy Jones, Kentucky State Office of Rural Health
J Scott Judy, Health Kentucky
Gil Lawson, Kentucky Cabinet for Health Services
Rice Leach, Kentucky Department of Public Health
Lamone Mayfield, Green River District Health Department
Mark McGuire, Kentucky Department of Insurance
Alan McKenzie, Project Access, Asheville, N.C.
Janie Miller, Kentucky Department of Insurance
Dr. Don Neel, Owensboro pediatrician
Curt Newcom, Owensboro pharmacist
Carol Palmore, Kentucky Department of Personnel
Barbara Quick, Help Office
Rose Rexroat, Kentucky Free Health Clinic Association
Jeremy Russom, Project Access, Asheville, N.C.
Joseph Smith, Kentucky Primary Care Association.
Lisa Travis, U.S. Office of Pharmacy Affairs
Laurel True, Kentucky AARP and Foundation for a Healthy Kentucky
Sheila Schuster, Foundation for a Healthy Kentucky and Kentuckians for Health Reform
We would like to acknowledge the invaluable assistance of Susan Sommerfeldt in conducting interviews and gathering information for this report.
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POLICY AND DATA
Henry J. Kaiser Family Foundation
www.kff.org and www.kaisernetwork.org
Serves as a policy institute and forum for analyzing health care coverage, financing and access for the low-income population and assessing options for reform. It also publishes daily and weekly updates on many health topics including prescription drugs.
National Aging Information Center
Provides list of prescription-drug-related web sites, including those with Medicare information, statistics and research, consumer information, etc. Note that prescription is misspelled in the web address!
Provides reports, research and policy information on trends in prescription drug spending. Funded by coaltion of major stakeholders including AARP, insurance companies, etc.
Not to be confused with Ashevilles Project Access, this is a program funded by the Robert Wood Johnson Foundation which provides information on health-care access for communities including publications such as Handles for Organizing a Healthy Community.
Community Access Program
U.S. Bureau of Public Health Care
Provides funding for community projects, such as SKYCAP in Eastern Kentucky, which address the health-care needs of the underserved.
Community Voices: Health Care for the Underserved
Aids in community-based solutions for health care including publications such as Increasing Access: Building Working Solutions, published in June 2000.
Provides a range of helpful publications and reports for communities and agencies wanting to help the underserved including Designing a Consumer Health Assistance Program.
Kentucky Homeplace and SKYCAP
University of Kentucky Center for Rural Health, Hazard, Ky.
Britt Robinson, Homeplace director, ext. 317
Fran Feltner, SKYCAP director, ext. 257
Uses a system of lay workers to meet the health and other needs of people in far western and southeastern Kentucky.
Louisville and Jefferson County Communities in Charge Coalition
Shavonne Coleman, project assistant
www.communitiesincharge.org (for information on Louisvilles and other programs)
Coalition/getCare Health Plan is streamlining health services for the uninsured in Kentuckys largest community. Funded with $1.5 million from a national foundation and local contributions, GetCarehealthplan will use case managers and the countys computerized public-health database to coordinate and improve services to the uninsured whose income is 200 percent of poverty (about $35,000/year for a family of four) or below. Among other things, the coalition will help the uninsured get prescriptions for free or low-cost drugs through drugmaker programs and Health Kentucky.
Models that Work Campaign
U.S. Bureau of Primary Health Care
Gives details of community health-care models that have been proven effective. Also offers strategy transfer guides.
304 Summit St.
Ashveille, N.C. 28803
Provides health services including prescription drugs to the underserved in the community; serves as a model for several other communities across the country.
Volunteers in Health Care
www.volunteersinhealthcare.org and www.volunteersinhealthcare.org/Reports/RX.htm (for starting a pharmaceutical program)
Provides information about how other communities address prescription drug and other health issues. Also provides software to assist wsith making application to drugmaker programs for free drugs for the indigent.
PHARMACEUTICAL PROGRAMS AND RESOURCES
Association of Clinicians for the Underserved
501 Darby Creed Rd., Suite 20
Lexington, Ky. 40509-1606
Provides information to clinics and agencies serving the poor about how to tap into federal and other programs which can help with prescription drugs.
M&D CARES, 1-888-246-1085
MedData Services, www.meddataservices.com
RxAssist Plus, www.rxassist.org
Drugmaker program applications
Needymeds, www.needymeds.com (for general public)
RxAssist, www.rxassist.org (for doctors and other providers)
RxHope, www.rxhope.com (for doctors and other providers)
Other states assistance programs
www.ncsl.org/programs/health/drugaid.htm (click on public user)
Patient initiated programs
The Medicine Corner, www.themedicinecorner.com
The Medicine Program, www.themedicineprogram.com
Indigent Patient Services, www.gihs.com/ips/index.html
American Medical Pharmaceutical Outlet, www.medshelp4u.com,
1-888-956-5802 (not in pamphlet)
Pharmaceutical Research and Manufacturers of America
Offers directory of drugmaker assistance programs for the elderly. Call 1-800-762-4636 for a copy.
U.S. Office of Pharmacy Affairs
Bureau of Primary Health Care
Heath Resources and Services Administration
Administers the 340B discount prescription drug pricing program, the HRSA prime vendor program and clinical pharmacy demonstration projects. Its pamphlet on Simplifying Pharmaceutical Assistance Programs includes the following resources that can help local agencies or clinicians:
LOCALLY AVAILABLE PROGRAMS
The Boulware Center Mission
731 Hall St.
Owensboro, Ky. 42303
Linda Roberts, program director
Rosemary Lawson, executive director
Provides emergency and transitional housing for those who are chemically dependent and trying to get sober, serves its own residential clients. A local pharmacy helps it provide prescription medications. The center also networks with service providers such as River Valley Behavior Health and Western State Hospital, which has a $5 charge-per-prescription program.
Daviess County Diabetes Coalition
Janice Haile, program coordinator
270-686-7747, ext. 5562
Starting a patient-assistance program to cover supplies and medications on an emergency, temporary basis until other ways of paying for them can be arranged.
Free Clinic of Owensboro, Inc.
1600 Breckinridge St.
Ownesboro, Ky. 42301
Cleona Durham, director
Serves working uninsured people with incomes of up to 185 percent of the poverty level. It files paperwork with drug companies and dispenses medicines. The clinic also has a $22,000 annual budget for generic medications.
Green River Area Development District
3860 U.S. Highway 60 West
Owensboro, Ky. 42301
Prescription Drug Assistance Program
Dana Froehlich, coordinator
Uses volunteers to help the needy complete the paperwork necessary to qualify for drugmaker assistance programs. The ADD also provides general benefits counseling.
The Green River District Health Department
1600 Breckenridge St.
Owensboro, Ky. 42301
Lamone Mayfield, executive director
Gail Wigginton, program director/administrator
Files paperwork for drug-manufacturer programs, mostly for residents of outlying counties because of the proximity of the Free Clinic. Also, other services are available in Daviess County.
12700 Shelbyville Rd.
Louisville, Ky. 40243
J Scott Judy, executive vice-president
Administrative office: 502-245-4214
Hotline for patients: 1-800-633-8100
Provides free medical care for the uninsured whose income is lower than the federal poverty level, currently $16,700 per year for a family of four. Patients call the hotline number to get help determining eligibility and finding a doctor. Prescriptions for Health Kentucky patients are free at participating pharmacies, which are then reimbursed with drugs by participating drugmakers.
Help Office of Owensboro, Inc.
1316 W. 4th St.
Owensboro, Ky. 42301
Barbara Quick, director
Pays for prescriptions for people who are qualified through a brief interview. they are referred to a pharmacy that quotes the lowest drug price.
The Immediate Care Center
1200 Breckenridge St.
Owensboro, Ky. 42301
Michele Hartung, operations manager
Provides free samples if available.
Local school systems in Daviess County
Use funds donated by the Rotary Club for medical care and/or prescription and over-the-counter drugs. The fund is used for children who have pressing needs but whose families, in most cases, do not have insurance and do not qualify for the Kentucky Childrens Health Insurance Program.
501 Walnut St.
Owensboro, Ky. 42301
Linda Dant, manager
Assists patients by filing the paperwork for drug-manufacturer programs; the patients pick up the drugs at the clinic. It also provides free samples or refers to other sources of help, including the Help Office.
Multicare of Owensboro
3515 Frederica St.
Owensboro, Ky. 42301
Shannon Forehand, office manager
Provides free samples when available and helps family-practice patients obtain prescriptions through drug-manufacturer programs.
The Ohio Valley Medical Center
750 Salem Dr., Suite 1A
Owensboro, Ky. 42301
Brandi Pate, office manager
Helps patients get drugs through drug manufacturer programs.
OMHS Convenient Care Center
608 Frederica St.
Owensboro, Ky. 42301
Billie Campbell, manager
Jennifer Cecil, business and industry liaison
Provides free prescription samples.
OMHS Emergency Room/Pharmacy
811 E. Parrish Ave.
Owensboro, Ky. 42303
Debbie Enoch, director
Provides a limited amount of free drug samples when available to help patients until prescriptions can be filled.
River Valley Behavioral Health
1100 Walnut St.
Owensboro, Ky. 42301
270-683-4039 or 1-800769-4920 (appointments_
Helps patients get drugs through manufacturers and an income-based program through Western State Hospital. It also supplies some samples.
The St. Vincent DePaul Society
1001 W. Seventh St.
Owensboro, Ky. 42301
Pays the full cost of prescriptions for clients it deems needy through an interview; the money comes from the proceeds of its thrift stores. The society deals with two local pharmacies that it pays directly for the prescriptions.
American Medical Pharmaceutical Outlet
P.O. Box 1228
Shelbyville, Ky. 40066
Larry Mann, managing partner
Connects low-income people (generally individuals earning less than $16,000 and households earning less than $25,000 with no insurance) with free drugmaker programs. The cost is a onetime $20 registration fee plus a $10 processing fee for each application. It usually takes 10 to 12 weeks after submitting a form to get medication in supplies that last up to 90 days.
Caritas Health Services medicine bank program in Louisville
Sister Donna Kenney (initiator of the program)
Caritas Medical Center
South Louisville Community Ministries, 502-367-6445
Southwest Louisville Community Ministries, 502-935-0310
Fairdale Community Ministries, 502-367-9519
Shively Community Ministries, 502-447-4330
240 E. 7th St.
180 E. Maxwell Street
Lexington, KY 40508.
Clif Cason, director
1-859-255-1074 at Maxwell St. Presbyterian Church
1-852-243-0887 at the pharmacy on Saturday mornings
Distributes samples from drugmakers and retail pharmacists. Volunteers run
the pharmacy, which is open on Saturday mornings. Drugs go mainly to people
referred by local doctors or nurse-practitioners, but the pharmacy also tries
to serve anyone who cannot afford medications. The pharmacy also helps people
qualify for drugmaker programs.
Provides about $100,000 a year to help people pay for medicines to meet short-term needs. Administered by four community ministries in southern Louisville and Jefferson County. In addition to buying medications with the Caritas funding, the program links people to other programs that provide free drugs.
Foundation for a Healthy Kentucky
Laurel True, chair
Provides no direct assistance but does research and recommends solutions to health-care problems. Has endowed health-care policy chairs at the universities of Louisville and Kentucky.
Kentucky Free Health Clinic Association
Rose Rexroat, director
Clinics help clients apply for free prescriptions from drugmakers and Health Kentucky and dispense free drug samples provided by physicians which work with them; some clinics purchase medication for patients if its not otherwise available. Still others, such as St. Lukes in Hopkinsville, work directly with pharmacists. Charitable contributions from the community support the bulk purchase of medications.
Louisville/Jefferson County Communities in Charge or getCare Health Plan
Coalition/getCare Health Plan is funded with $700,000 from the robert Wood Johnson Foundation and $780,500 from a coalition of local groups including government and health-care and medication to the uninsured whose income is 200 percent of the poverty level (about $35,000/yr for a family of four) or below. its services will include helping the uninsured find ways to pay for prescription drugs through drugmaker programs, Health Kentucky and other avenues.
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