Prescription for Perplexity

Some Poor People Face a Dizzying Path to Free Drugs From Industry

Every day, Priscilla Watson needs 12 drugs to manage high blood pressure, diabetes, allergies and other health problems. Like thousands of other poor people in the District, she can't afford them.

But she stays well by getting all her prescriptions filled free through a social services agency that taps individual drug companies' indigent care programs and arranges for product donations to eligible patients.

Since last fall the Pharmaceutical Resource Center, a city-funded service of Catholic Charities of the Washington Archdiocese, has obtained $2,878 worth of free medications for Watson, 61, who gratefully picks up three-month supplies from her regular clinic. The center said it has helped about 600 elderly or disabled patients by arranging for $1.7 million worth of drugs in the past year.

Officials said Watson, a Medicare beneficiary and former nursing home worker, saves perhaps $450 a month. She said she otherwise would be desperate because she lives on a modest monthly disability check. "I would be a homeless person," she said. "This is a blessing from God."

Other needy residents aren't as lucky as Watson. They are unable to navigate a confusing array of patient assistance programs run by the drug companies, individual clinics, pharmacy benefit managers and the District government.

Specialists say that figuring out the system is difficult. When it comes to dispensing life-saving prescription drugs for the poor, they say, the District's situation is fluid and volatile.

"The District is in no way in a bigger mess than anywhere else in the country, but the reality is that people . . . can't get their medicine," said Sharon Baskerville, executive director of the D.C. Primary Care Association, an advocacy group for charity clinics. "To get their medicine, people have to wend their way through lots of craziness. The most vulnerable people don't make it through. They can't get the drugs they need and end up in emergency rooms or in the hospital needlessly. Or they die prematurely."

In a federally funded study released last week, researchers reported that middle-aged and older patients with heart disease who cut back on their prescribed medications because of cost were 50 percent more likely to suffer heart attacks, strokes or angina than patients who did not ration their drugs at levels below their prescribed dosages and frequency.

The decline in patients' health was monitored over two to three years, suggesting to researchers that economic barriers to prescription drug use may cause problems quickly, not just in the long term, according to the lead author of the study, Michele Heisler of the Veterans Affairs Ann Arbor Healthcare System in Ann Arbor, Mich.

The hodgepodge of prescription drug and patient assistance services in the District is uncertain these days. In May, the Pharmaceutical Research and Manufacturers of America launched Rx4DC, a service similar to that provided by the resource center. The main differences are that it has no limit on how many people it can serve and that patients are on their own in managing the substantial paperwork.

But like the resource center, it faces an unknown future. It could last for years, or its reach could change abruptly, depending on what happens on Capitol Hill.

The $217-billion-a-year pharmaceutical industry's move to set up Rx4DC came days after Mayor Anthony A. Williams (D) signed Access Rx, a law requiring drug companies to sell medications to the District at discount rates, and to disclose pricing, marketing and contracting data. The city would make the drugs available to seniors and the uninsured and pass the savings along to them.

This week the D.C. law came under legal attack. The Pharmaceutical Care Management Association, the trade group for the nation's pharmacy benefit management companies, filed suit in U.S. District Court to block the part of the law that forces those firms to reveal all financial arrangements between them and drug makers. Benefit managers administer prescription drug plans for more than 200 million Americans with drug coverage in their health plans.

The association has a similar suit pending in Maine, whose law was a model for the District's Access Rx law. A federal judge there has issued a preliminary injunction against enforcement of that state's law until a trial is held in 2005.