Why Can Some Patients Get Free Drugs While Others Can't?

Many pharmaceutical companies offer free drugs, but critics complain such Patient Assistance Programs don't go far enough

Six years ago, Carla Miller was an active woman who enjoyed outdoor activities such as camping. Then things started to go wrong. "I just had tremendous pain that would kind of come and go," she says. "It started in my knees and then it moved to my hands and feet." She was diagnosed with rheumatoid arthritis, an autoimmune disease that attacks the joints. Two years ago Miller, now 53, discovered she also had a rare disease that affects her lungs. "If I moved too fast or lifted a heavy object I would become short of breath," says the former office worker. "I tried to work and would become very ill and had to go home."

When Miller's doctor suggested Humira, an injected medicine manufactured by Abbott Laboratories (ABT) for her arthritis pain, she didn't think she could afford the nearly $300 co-pay. Her doctor suggested applying for a co-pay assistance program through the pharmaceutical company that makes the drug. She applied and received a card in the mail with which to purchase her medication. "They called and said I was approved and that my co-pay was going to be zero," Miller says. "I couldn't take [Humira] without it."

Most large pharmaceutical companies offer financial support, and some help underinsured patients through co-pay programs. Many states offer assistance, too. "There's still a lot of people who don't know about [these programs]," says Dr. Richard Sagall, the president of His Web site compiles information about patient assistance programs (PAPs). "Some of the companies give away very expensive drugs easily." Sagall started the site a dozen years ago, when he was a family and occupational physician in Bangor, Me. He found out about the programs and decided to put his recently learned Web site designing skills to use. "I thought I was a pretty socially aware person, but I hadn't heard of them," he says.

Complicated Forms

Sagall warns that it may not be easy for some people to apply for the programs. "There are other companies that are very difficult to work with," he says. The application forms can be complicated, and patients might be rejected "if you forget to dot an i or cross a t." Still, "It is free medication for those who can't afford it," he says.

For Miller, who lives near Tampa, it was a godsend. She had been laid off from work because she couldn't work full-time and qualified for disability assistance more than a year later. Her husband, a plumber, was laid off last year and is still looking for work.

What's the best way to start the process? First, talk to physicians, who should be aware of these programs.,, and all assemble information about PAPs. States post information online about financial assistance for residents. It takes patience and persistence to navigate the system, but for those who are willing to make the calls and do the research, the benefits can be immense.

Easier to Qualify

The recession has had an effect on many people's ability to pay for their prescriptions. Some companies are responding with improved payment options. Merck (MRK), which makes such common drugs as Singulair for asthma and Januvia for diabetes, increased the amount of total annual income a family can make and still qualify for free medication in March. Individuals making less than $43,000 and families of four making less than $88,000 now make the cut. Over the last seven years, Merck says it has helped 1.7 million patients with $1.9 billion of medicine. Merck made $23.85 billion in worldwide sales last year.

Biogen Idec (BIIB) has a payment plan for two of its multiple sclerosis drugs, Avonex and Tysabri. "We are committed to helping patients, and that commitment is evident in the $140 million of financial assistance we provided in 2008," spokesperson Shannon Altimari said in an e-mail. That accounts for 5% of the $2.79 billion in revenue that the company made from the two drugs in 2008.

Pfizer (PFE) announced a program in May called Maintain that provides free medication to unemployed patients who lack prescription drug coverage. Maintain is one of several patient assistance programs that the company offers.

Chicago-based Abbott Laboratories, which makes Miller's Humira, has provided that medication to patients in need since it came onto the market. The company introduced a Humira Protection Plan in March that helps reduce co-pays for insured patients to $5 per month. "The plan was really a response to patient and physician feedback that they needed more support," says Abbott spokesperson Elizabeth Hoff. The company earnings release says it gave out $255 million of free medicine last year and made $29.5 billion in sales. Total U.S. sales for Humira in 2008 were $2.25 million, but the company does not break out how much was given away.

Some people say that these offerings avoid the real problem. Larry McNeely, a health-care analyst at Washington (D.C.)-based U.S. Public Interest Research Groups (PIRG), says: "They're a Band-Aid on the gaping wound of unaffordable prescription drugs." He says that the high cost of medicine is a systemic problem that can only be fully addressed with legislation. "This is not a struggling industry. This is not automobiles," he says. "They're raking in profits."

Hit-Or-Miss for Patients

McNeely does not like the fact that PAPs are so hit-or-miss for patients. He worries that people have "tried to go through these programs and gotten lost in the shuffle." He advises patients to read the fine print and be careful not to get stuck without medication while waiting for approval.

Cynda Moss has experienced such problems. The 56-year-old retired teacher was diagnosed with Parkinson's disease in 1999, followed by lung cancer in 2001. Her income from social security and teacher retirement barely stretches far enough to cover her mortgage, medical bills, and other living expenses. "I have tried all sorts of avenues to see if I can get assistance with the drugs," she says. She called representatives for her pharmaceutical companies, Social Security, and Medicare. She has also followed several leads on the Internet. But because she has insurance, "they immediately tell me I'm disqualified," she says.

Moss' prescriptions can cost as much as $20 per pill, and her medical expenses are more than $500 per month. "There are times when I have had to forgo a pill or two here or there," she admits. Moss is not sure what the future holds for her.

While McNeely at PIRG believes that there needs to be a change in the system, he says: "If folks need assistance, don't give up. There are some potential options out there." Miller is one of the success stories. She says that because of her arthritis medication, "I have a chance at becoming a little bit more normal."

Click here to see what you need to do to find a patient assistance program that is right for you.

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