A year ago Peg Huffom was paying $300 a month for her olanzapine (Zyprexa) prescription, but now she is getting her refills for $12 a month courtesy of a prescription drug discount program from Eli Lilly called Lilly Answers.
She is one of a slowly growing group of Americans who are taking advantage of a mixed bag of drug discount programs offered by pharmaceutical companies, insurers, and Medicare.
Huffom, an 83-year-old resident of the Northwesterly, an assisted-living facility in Lakewood, Ohio, is a member of a Medicare HMO that provides a prescription drug benefit, which covers most—but not all—of her monthly drug costs. Olanzapine, for example, was not included on the list of covered drugs, she says. “But my doctor did some research and he found this program for me,” she explains. “He found a program at Pfizer, too, but I wasn't eligible,” she said. The Pfizer program, called Pfizer Friends, offers savings of 37 to 50 percent on Pfizer drugs.
Pharmaceutical Company–Sponsored Cards
In fact, most of the major drug companies offer discount programs similar to the Lilly Answers plan, but eligibility rules vary and tracking down an appropriate program often requires the help of a physician or someone who has the time and energy to research the options.
For uninsured Americans a new discount program called Together Rx Access Care may cut some of that red tape. It is a joint program sponsored by 10major drug companies.
The program allows those who meet income and age requirements to save 25 to 40 percent— and sometimes more— on more than 275 brand-name prescription drugs and a host of generic drugs. This is the second joint effort by the drug companies; in 2003 seven companies joined forces to offer a discount card for low-income seniors called Together Rx, which now has 1.5 million cardholders.
Roba Whitely, executive director of Together Rx Access Care, says the new card is “free and it offers real savings.” To qualify for the card, applicants must be under 65, ineligible for Medicare, and have no other private or public drug coverage. They also must have incomes no higher than $30,000 for a single person, $40,000 for couples, and $60,000 for a family of four.
Many of the top selling drugs—like atorvastatin (Lipitor), sertraline (Zoloft), and celecoxib (Celebrex), all made by Pfizer—are covered by the Together Rx Access Care card. But card holders won't know the exact discount they get until they check at their local pharmacies because cooperating pharmacies are also offering their own discounts for each drug, says J. Patrick Kelly, president of Pfizer's U.S. pharmaceutical business.
The discount programs are long overdue, says Guy McKhann, M.D., a professor of neurology and neuroscience at Johns Hopkins University in Baltimore. Several years ago, Dr. McKhann and some colleagues at Johns Hopkins held several meetings with pharmaceutical companies in an effort to get a discount prescription card off the ground, but they were unsuccessful.
“Patients with neurological disorders are good candidates for prescription plans because they are taking medicines for the rest of their lives and their options are not that great. The number of medications to choose from is small and in many cases—such as multiple sclerosis—the drugs are very expensive, so anything that can decrease the cost to patients would be well worthwhile,” Dr. McKhann explains.
Medicare Prescription Drug Discount Cards
While the pharmaceutical industry and private insurers have been offering drug discount cards for years, the biggest player in the drug discount card arena is Medicare, which included a prescription drug benefit in the Medicare reform bill that was passed in 2003. Under that plan, all Medicare beneficiaries are eligible for a Medicare-approved drug discount card. Moreover, a single Medicare recipient who earns $12,569 or less a year or married couples earning $16,862 are eligible for a $600 credit for buying prescription drugs. This discount card is a temporary program that will be phased out when the Medicare comprehensive drug benefit is rolled out in January 2006.
But the Medicare program got off to a rocky start. In the year since Medicare made the discount cards available, millions of senior citizens have still not enrolled. One possible reason for this is confusion over both eligibility and a dizzying array of choices, since Medicare doesn't offer a single “Medicare card” but rather dozens of cards that are Medicare-approved.
For example, at the Northwesterly, where Peg Huffom lives, only one of the 50 residents gathered for lunch had a Medicare drug discount card. That woman said she had the card because her son had spent time doing the research and filling out forms necessary to get the card.
Northwesterly resident Eleanor Crum voiced a concern raised by many of the Northwesterly residents when she noted, “I don't believe those cards really work.” Moreover, about half of the residents interviewed by Neurology Now said they didn't know anything about the discount program, which suggests that Medicare mailings and advertising campaigns are missing the mark.
Another resident, Ann Probst, says she had just recently received a letter from Medicare: “It was a long letter and it said that I could get my methotrexate (Rheumatrex Dose Pack, Trexall) for free if I applied for a card.” Probst says she hadn't applied for a discount card because she has a drug benefit through her Anthem/BlueCross/ BlueShield Insurance. “But,” she adds, “I just received a bill for $900 for prescriptions, so I think it's time to apply for a card.”
Drug Costs Vary
The AARP supported the Medicare reform bill that created the discount drug card program and, late last year, the AARP Public Policy Institute issued a report that studied variations in drug prices in the 33 Medicare approved cards. Since prices change, it's difficult to rate the cards, but getting one does provide savings, the institute found.
“If you don't have drug insurance now, then it makes sense to get one of these cards,” says Keith Lind, a senior policy advisor at the AARP institute.
Not all cards cover all drugs—and some drugs such as the anticonvulsant clonazepam (Klonopin, Rivotri) are excluded from the Medicare coverage— but at the Medicare site one can match cards to drugs covered. But, according to Lind, many people say they don't want to click their way through the government Web site. Instead, he suggests picking one of the low-price cards identified in the report. Those cards are: Walgreens ($20), myPharmaCare ($25), and EnvisionRx Plus ($30).
In its report, for example, the AARP found significant differences in prices for four commonly priced prescriptions used to treat acid reflux, allergies, osteoporosis and depression.
But consumers need to learn how to maximize card benefits, Lind says. For instance, the myPharmaCare card is honored at many drug stores but the card, which is a CVS Pharmacy subsidiary, delivers the deepest discounts when used at a CVS.
So, the best advice about drug discount programs? Do the research, compare the options, and pick a card.
Need More Information on Drug Discount Cards?
For information about the Medicare discount drug card programs, visit the Medicare Web site at www.medicare.gov; click on the link to available Medicare-approved discount drug cards, or call toll-free (800) MEDICARE(800) 633-4227 or TTY (877) 486-2408).
People who qualify can enroll in the Together Rx Access Card program free of charge by calling 800-444-4106, or visiting www.TogetherRxAccess.com. For enrollment criteria, see “All About Drug Discount Cards.”
The Volunteers in Health Care, Rx Outreach program offers 50 generic medications for a wide range of conditions including diabetes, asthma, heart disease, and depression. You can enroll in the program even if you use another discount drug card. The program is available to individuals and families with incomes of up to $47,000 for a family of four. Click on www.rxoutreach.com/en/vih/.
A good resource for people who need help paying for brand-name drugs is https://www.helpingpatients.org. This pharmaceutical company–affiliated Web site offers a complete directory of drug company–sponsored drug discount programs.
All About Drug Discount Cards
If you are one of the millions of Americans who doesn't have prescription drug coverage through health insurance, a drug discount card is a good way to reduce your out-of-pocket prescription drug expenses.
Most Medicare recipients are eligible for a Medicare-approved discount drug card. Medicare doesn't issue drug cards, but it does approve a number of cards for Medicare recipients. These are the factors you should consider when selecting a Medicare-approved discount drug card:
Is the card accepted at your local pharmacy? Some cards offer the best prices on drugs when the cards are used in specific pharmacies—for example, using a Walgreen's card in a Walgreen's pharmacy. You can find a list of Medicare-approved cards as well as the drugs that are covered by Medicare-approved drug discount cards at the Medicare Web site (www.Medicare.gov). Follow the links to approved drug discount card.
The AARP web site offers a primer on discount drug cards, including a form you can use to determine the most cost-effective card for you. It's available at www.aarp/bulletin/prescription/ or write to 601 E Street, N.W., Washington, D.C. 20049
Most Medicare-approved cards have a user fee, typically in the $25 to $35 range, although some cards are more expensive. Information about user fees is also available at the Medicare website.
If you are not a Medicare recipient, you may qualify for Together Rx Access Care, a free drug discount card program sponsored by 10 major drug companies. The program allows those who meet income and age requirements to save 25 to 40 percent—and sometimes more—on more than 275 brand-name prescription drugs and a host of generic drugs.
Together Rx Access Care eligibility criteria
Applicants must be younger than 65, ineligible for Medicare or other private or state drug coverage programs.
Income limits are $30,000 for a single person and $60,000 for a family of four.
In addition to these programs, pharmaceutical companies offer drug discount card programs that can be used to purchase company-manufactured drugs at discount prices. Eligibility for these programs varies. In some cases these company cards can be used in conjunction with other drug discount programs.
Drug company programs:
Orange Card—GlaxoSmithKline (888) 672 6436, Care Card—Novartis (866) 974-2273, Share Card—Pfizer (800) 717-6005; www.pfizerforliving.com/ sharecard Lilly Answers (877) 795-4559; www.lillyanswers.com