Drugmakers Offer Aid To People 'on the Edge'

"I have heard all sorts of suggestions about companies' motivations from all sorts of different people," Sagall says. "Companies tell you that they want to be good corporate citizens, [but there's] also a marketing portion of what they do." Needymeds itself is funded by donations, including some from drug companies, and "works with the Patient Assistance Programs of several pharmaceutical distributors." But the sheer volume of information on the site and the fact that competing companies are listed makes it hard to point to a profit motive.

"We do not use financial consideration for a basis for who gets listed," Sagall says. "We have to raise money -- we don't turn it down -- but it doesn't influence what we do."

Whatever motivates companies to start PAPs, the people who cannot afford prescriptions can't afford to ask. Established in 1994 to distribute donated medication to needy patients, the Arlington Free Clinic soon began connecting clients to PAPs. But because each PAP requires a separate application for each patient, service providers found themselves drowning in paperwork. When a clinic volunteer who also worked at AstraZeneca suggested that the company provide free medication in bulk, the drugmaker certified the clinic as a "disproportionate share hospital" -- that is, a health-care facility that disproportionately serves under-insured people with low incomes. The result? More medication, less bureaucracy.

"That was terrific," says Kate Wilson, director of clinical services at the Free Clinic. "[AstraZeneca] said, 'We realize that you have eligibility criteria for all of your patients. If you can verify that patients [are eligible for services at] your clinic, we will give you medications as you use them.' "

The Free Clinic is a PAP success story, but how the clinic learned of the program -- from a helpful volunteer -- highlights the communication gap between those who offer and those who need free medication. Despite the existence of Web sites such as Needymeds.com and publicity campaigns by Big Pharma, PAPs fly under the radar of many who may qualify.

Unless a proactive doctor steps forward with information, patients continue to spend money at the pharmacy that could be spent on food or gas.

Wilson is a good example. She used a PAP to get free medication for her ailing mother. "It was because I worked here that I realized one of the meds she was on was available through a PAP," Wilson says. "It's not an easy process for an individual."

"All programs require an application, income documentation and doctor involvement to some degree," Sagall says. "It's not quite as simple as ideally it would be."

Although not easy for the uninitiated to navigate, PAPs show how America's uninsured might soldier on without universal health insurance. It certainly seems that Patricia Hewitt, weighed down by her monthly prescription laundry list, would favor a greater role for government in health care. Surprisingly, she's less than enthusiastic.

"The government couldn't possibly cover what I am already getting," Hewitt says. "I am much better off with Needymeds and a considerate doctor."

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