Prescription for Perplexity
Experts say elements of the drug industry have sued in every state where such laws have been passed and have succeeded in delaying them.
The D.C. law has not taken effect because it is still being studied by a city interagency task force that has a monumental challenge: The law regulates drug purchases for every kind of government program. It does not apply only to low-income people. The litigation won't change anything, officials said.
"We're trying to implement the bill, and we're trying not to let anything [the pharmaceutical industry] is doing get in the way of that," said Gina Lagomarsino, a senior health policy adviser in the city administrator's office.
Rx4DC is a public relations ploy, said Sidney Wolfe, head of the Public Citizen Health Research Group. "The pharmaceutical industry is doing everything possible to do things to make people hate it less, and generally it is not working," he said.
"If you're poor, and there is no other alternative, we are not saying don't take advantage of the programs," Wolfe said. "But it really doesn't solve the larger problem. . . . Even Medicare beneficiaries with a reasonable income can easily be wiped out by having to spend up to $10,000 a year on prescription drugs. The companies are charging whatever the market will bear."
According to Public Citizen, a liberal public interest group, the drug industry spent a record $108.6 million on federal lobbying in 2003 -- mostly to make sure that Medicare changes adopted in November did not impose price controls on drugs for the 41 million Medicare beneficiaries.
Some low-income patients have come up with surprising health maintenance methods when they can't obtain their prescription drugs.
George Wallace, a 72-year-old Medicare patient who lives in Northeast D.C., said that when he could not afford blood pressure medication, he regularly mixed a glass of water with a teaspoon of vinegar to control his hypertension. "It's been helping me -- I'm serious," said the retired janitorial service worker. "But the medication is better."
Donald W. Cole, 78, a retired chauffeur who lives in Northeast on about $9,000 a year in Social Security payments, said he could not afford his three regular prescriptions before enrolling at the Catholic Charities resource center.
"There were times when [the clinic pharmacy was] not going to give me medicine without my paying full cost," he said, so he visited the clinic administrator. "I just got hysterical. I thought what would happen to me had I not had the funds to continue taking these medicines. I must have babbled like a little baby."
The clinic got him a free supply of the drug, but later he switched to another provider, and now the resource center is helping him. "It's like they give me my breath," Cole said.
The Medicare prescription drug program is to begin in earnest in 2006, and that will put more wrinkles into the everyday decisions of low-income people who need prescription drugs.
Also in recent months, the federal government launched its Medicare drug discount card program, which gives a $600 credit to certain low-income Medicare beneficiaries. There has been much criticism of the program, especially by people who say it's too confusing.
No one knows how assistance programs will evolve, which ones will survive and whether patients who can't navigate a complex system will continue winding up in hospitals recovering from health crises that could have been prevented with medications.
© 2004 The Washington Post Company
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