Resources on Pharmaceutical Costs and Access

• "Supplier drops Illinois' drug-import plan" - The Canadian supplier of low-cost drugs to Illinois' much-hyped but illegal drug-import program has dropped out, bemoaning the state’s lip service to its promotion."  State Register-Journal, 1/26/09.     
   

  Medicaid: Pharmacy Program Characteristics (Chapter 4)  |  SPAP: State Pharmacy Assistance Programs (Chapter 6) 

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  Prescription Drugs: Overview of Approaches to Control Prescription Drug Spending in Federal Programs - report by US GAO, 6/24/09.

• Federal Courts deny bid to limit Vt. law on prescription data.  The Supreme Court has refused to review the decision of the First Circuit Court of Appeals to uphold New Hampshire’s prescribing data-mining law.  Modern Healthcare, 6/29/2009. 

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  Health Spending Projections Through 2018: Recession Effects Add Uncertainty To The Outlook.  Health Affairs, Feb. 24, 2009.

   U.S. Sen. Richard Burr: National health plan would deter drug development- article by Triangle Business Journal (NC), 4/16/09 

Patient Assistance Now by Novartis - This newly expanded service links to Novartis products at no charge or at a discount and includes related PAP features and consumer information.  8/08.

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  "Americans pay the most for prescription drugs and still don't take them" - An international study of dialysis patients shows that although U.S. residents have the highest out-of-pocket drug costs, even those who can afford their prescription drugs are far less likely to take them than patients in other countries. Published by Arbor Research Collaborative for Health, U. Mich, 1/8/08.

  "Assessment of Authorized Generics in the U.S." - Prepared for: PhRMA by IMS Consulting, 3/06. [ PDF, added 10/08]

   

• Prescription Drug Expenditures in the 10 Largest States for under 65, 2005 - MEPS Survey data, published by AHRQ, January 2008. [6 pages, ] 

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  State Prescription Drug Price Web Sites: How Useful to Consumers? -report by Center for Studying Health System Change, 2/13/08.

   

• Report: State Drug Price Sites Flawed - as reported by Associated Press,  2/13/08.

• "Prescription Drugs: Trends in Usual and Customary Prices for Drugs Frequently Used by Medicare and Non-Medicare Health Insurance Enrollees" GAO Report to Congress 9/7/07. [14 pages, PDF]

• 2008 Preferred Medication List—Medication Categories Guide - This Walgreens PDL provides one example of a commercial use of PDLs; (Its inclusion here is illustrative only; and does not imply NCSL endorsement or opposition).  Effective January 1, 2008. 

• Attorneys General Pharmaceuticals Conference by the National State Attorney General Program at Columbia Law School in New York, 5/10-11/07.  It featured latest information on pricing and marketing fraud legal cases, state laws and challenges to them, payments to doctors and more.  Most materials are now posted on the web, including:

  • "Paying Less by Purchasing Smarter" by Prof. Anderson, Johns Hopkins, MD

  • Pharmaceutical Bulk Purchasing: State laws and actions by Richard Cauchi, NCSL Health Program

  • Effective Preferred Drug Lists, by Medi-Cal Pharmacy Director Kevin Gorospe

  • "Presenting Truthful Information to Doctors" Dr. Kasselheim, Boston, MA

     

• NJ Prescription Drug Retail Price Registry "helps consumers compare the retail prices charged by many pharmacies for the 150 most-frequently prescribed prescription drugs" based on 2006 signed law. 

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  Controversies in Drug Substitution - Medscape pharmacists 11/14/07.

  Deficit Reduction Act Of 2005: Impact On The Medicaid Federal Upper Limit Program - Office of the Inspector General, June 2007. [46 pages] 

   

"Physicians’ Experiences Using Commercial E-Prescribing Systems" - A Health Affairs web exclusive concludes physicians are optimistic about e-prescribing systems but face barriers to their adoption. Health Affairs, 4/6/07. 

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• Health Spending Projections Through 2016: Modest Changes Obscure Part D’s Impact.  Over the next decade, U.S. health care spending is expected to double from today’s level, reaching $4.1 trillion and consuming almost twenty cents of every dollar spent, federal forecasters report in an article published in Health Affairs Web Exclusive. Health spending in 2006 is projected at $2.1 trillion, which accounts for 16 percent of the gross domestic product. The average annual growth in health care spending is projected to remain relatively steady at 6.9 percent from 2006 through 2016.  (Health Affairs, 2/21/07)

• Tennessee: 4,200 apply on first day of CoverRX enrollment; Prescription-drug plan targets uninsured, poor. News from Tennessean, 1/4/07.

• Insurance Coverage Of Biopharmaceuticals -"breakthrough biopharmaceuticals pose a difficult challenge to existing arrangements for financing care because of their high costs, the small patient populations they often serve, and problems in measuring their incremental therapeutic value..." Health Affairs, Sept/Oct 2006.

• Qualified State Pharmaceutical Assistance Programs (SPAPs) under the MMA - easy-to-read summary of CMS data, 8/06.

• "Hope, at $4,200 a Dose," Because of the economics of the cancer drug market, price does not seem to hurt a drug's popularity. story by New York Times, 10/2/06.  

  State Perspectives on Emerging Medicaid Pharmacy Policies and Practices - report by the National Association of State Medicaid Directors (NASMD), 11/13/06 [ PDF, 45 pages]

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  "Medicare: Negotiated Drug Prices May Not Lower Costs" NCPA free market analysis, 12/18/06. [ PDF 2 pp]

  "Shopping for Drugs: 2007," National Center for Policy Analysis describes how "aggressive consumers can reduce the cost of some common drug therapies by more than 90 percent." NCPA Policy Report, 11/15/06. [44 pages] 

   

   The Impacts of Breakthrough Drug Classes on Total Health Expenditures" - A scientific study "examining six different groups of breakthrough drugs, including the SSRIs, Statins, Ace Inhibitors, H2 Antagonists, Proton Pump Inhibitors, Calcium Channel Blockers, and Fluoroquinolones. All drug classes except Fluoroquinolones provide substantial cost savings on overall health care expenditures." -  Texas A & M Univ.  11/11/06. [41 pages]

   

  National ADAP Monitoring Project 2007 Report: Formularies from NASTAD and the Henry J. Kaiser Family Foundation, 4/07. [ PDF, 31 pages] 

   

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Private Patient Assistance Programs (free pharmaceuticals)

• Benefits Checkup helps people to find programs for people ages 55 and over that may pay for some of their costs of prescription drugs, health care, utilities, and other essential items or services." A service of the National Council on Aging.

   

• Partnership for Prescription Assistance (PPARx), sponsored by PhRMA.  Examples of state-specific free and discounted assistance information, '2008:

  • Massachusetts PPARx  |  Oregon PPARx  |  Tennessee PPARx -

• Patient Assistance Now by Novartis - This newly expanded service links to Novartis products at no charge or at a discount and related PAP features.  8/08.

• RxAssist is a web-based searchable database, providing "up-to-date information on accessing more than 70 manufacturers' programs."  Information on that project also is available by telephone, toll-free at 1-877-844-8442 or 401-729-3284.

• Rx Outreach is "an easy and affordable way for people of all ages to get more than 55 generic medications that treat a wide range of conditions including diabetes, asthma, heart disease, and depression. People may take advantage of the program even if they receive medicines through another discount program. The program is open to people with incomes of up to 250 percent of the federal poverty level. For a family of four, this figure is $53,000 per year.  [updated 2/08]

• RxHope.com is an online clearinghouse of no-cost and low-cost prescription drugs, described as a "patient assistance Internet initiative financially supported by PhRMA (Pharmaceutical and Research Manufacturers of America) and participating pharmaceutical companies.

• "AZ&Me" launched by manufactrer AstraZeneca in 2006, as a user-friendly patient assistance program. Eligibility requires annual income up to $30,000 for an individual; $60,000 for a family of four, no Rx coverage from other sources and a current prescription for an AstraZeneca brand product (including Nexium, Crestor, Merrem, Pulmicort, Seroquel®) and about 20 others. 

• Privately run state-based programs are hosted by:

  • MedBank Foundation of Georgia is a non-profit volunteer organization formed in 1992 to assist the uninsured in obtaining prescription medications free-of-charge from pharmaceutical companies. The organization works with citizens who reside in three Eastern Georgia counties (Chatham, Bryan, and Effingham.)
    Medbank of Maryland, now funded in part with state funds authorized beginning in 2001.  419,431 prescriptions were processed statewide for 34,847 patients as of June 2006.
    http://www.medbankmd.org/

  • Prescription Connection for North Dakota. The program is the result of state legislation passed in 2003, which appropriated $100,000 for it, with the Insurance Department providing another $100,000.

  • NeedyMeds a nationwide non-profit service that "help identify med cost assistance programs," now based in Massachusetts. Their web site claims 10 million visitors between 1997 and 2008.

  • The Virginia Rx Partnership is a public/private partnership which exists to provide free prescription medications for Virginia's eligible uninsured.  Since it was founded in 10/04 the state has appropriated $93,750 in general funds; manufacturers have provided $4.9 million in Rx to 5,600 patients as of December 2005, through bulk donations to 20 free clinics and community health centers. Previously the VA  Health Care Foundation ran a free program for more than five years.

Discount Card Programs - Public

• As of mid-2009, 27 states created or authorized programs that offer a discount only (no subsidy) for eligible or enrolled residents; of these about 19 are in operation.  The latest are in Colorado, Florida and Iowa, starting in 2008.  Some of these states also have a separate subsidy program. .  Descriptions and the current status of these programs are available on the NCSL's State Pharmaceutical Assistance Programs web page.

Discount Card Programs - Organizations/Pharmaceutical Manufactures/Others

There are several private-sector plans that offer to provide eligible individuals with discounts on some or all prescription drugs. Although these plans are not established or usually regulated by state law *, the following information is provided as examples for general and comparative purposes.  The claims listed by these programs have not been verified and are subject to change.

• Rx Outreach: Rx Outreach is a recent Patient Assistance Program developed by Express Scripts Specialty Distribution Services, Inc. (ESSDS). The program provides qualified low-income individuals and families access to generic versions of medications.  It is available to anyone with an income under 250% of the Federal Poverty Level (e.g., $24,500 individual; $32,075/couple; $50,000 for a family of four) and provides 110 generic drugs used for many chronic conditions.  It is termed "very affordable," with a fee of $20 to $30 for each 90-day prescription filled by mail order. The application form is simple and no supporting documentation is required.   The state of Georgia features this program on its GA Community Health Dept. website.
• Merck:   Starting April 2005, the Merck Prescription Discount Program will provide assistance when, where and how patients need it. It is innovative in several important ways: the program is offered to all uninsured patients, regardless of age or income.  Patients do not have to fill out complicated enrollment forms or wait for a card in the mail to access an immediate discounts on many Merck medicines. Patients can enroll in the Merck Prescription Discount Program to realize greater continuous savings.  The program is free-of-charge, easy to enroll in and use, and conveniently offered through almost all pharmacies nationwide. Plus, there are no annual membership fees for the life of the program.  Estimated savings is 15-40% per Merck prescription.  For more information, please click: http://www.merckhelps.com/uninsured/
• Together Rx Access card:  In early 2005 12 pharmaceutical manufacturers launched a new discount program, aimed at uninsured people of modest means younger than 65.  People can qualify for the cards if they are younger than 65 and not eligible for Medicare, if they have no public or private coverage for drug costs and if their annual incomes do not exceed $30,000 for an individual, $40,000 for a couple, $50,000 for a family of three and $60,000 for a family of four. The new program offers savings on 275 drugs including Crestor and Lipitor, for high cholesterol; Norvasc, for high blood pressure; Nexium, for heartburn and ulcers; Viagra, for erectile dysfunction; and Zoloft and Paxil, for depression.  The companies participating in the new program are Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Johnson & Johnson, Novartis, Ortho-McNeil, Pfizer, Sanofi-Aventis, Takeda and TAP Pharmaceutical Products.  Another 7 joined later in 2005. For more information, please visit: http://togetherrxaccess.com/
• Together Rx Card: Seven manufacturers joined together in April, 2002 to provide discounts "of approximately 20-40% on more than 130 medicines."  Eligibility includes Medicare beneficiaries with income of less than $28,000 per year ($38,000 for a couple).  Enrollment reached 1,458,439 cardholders as of December 2004, who have saved "more than $640 million." The program ended on December 31, 2005 with the start of Medicare Part D.
• AARP Prescription Savings Service is sponsored by the not-for-profit senior organization, AARP. It features a discount card that is free but only to those who also are AARP Health Care Options insured participants, and "it will not be valid if you discontinue your participation in AARP Health Care Options." On average, it provides "15% off of brand name drugs and 50% - 55% off of generic alternative drugs when you order for mail delivery." The program now is administered by UnitedHealth of Minnesota and run by Express Scripts.
• The Readers Digest YourXplan is a discount prescription program for individuals who don't have coverage, from the two names in health services and information: Reader's Digest and Merck-Medco Managed Care. For an annual fee of $25 for an individual and $40 for a family, enrollees get a card that entitles them to a discounted price at 40,000+ participating retail pharmacies or mail order.
• GlaxoSmithKline, in October 2001, launched The Orange Card, a discount program open to eligible persons age 65 and over. The program provides access to products only made by this manufacturer. The sponsors described it as a first-in-the-nation program. A Feb. 7, 2002 report indicated that 25,000 people had signed up.

• OPTIMIZERx™ offers special savings & free trial programs to help you better afford your prescriptions and over-the-counter medicines, beginning in late 2006.  It is described as "simple and free", requiring no additional enrollment into any insurance or pharmacy program.  Registration required for offers.

• National Association of Chain Drug Stores (NACDS) on March 11, 2002 announced the PharmacyCare OneCard "to give seniors easy access to an array of manufacturer discounts, open to all drugmakers." How to structure discounts would be up to individual manufacturers. The group said it would license the card to pharmaceutical claims processing companies meeting specific criteria. The program began enrolling eligible low-income seniors in April 2002. Income limits were not specified in the initial descriptions of the program.
• MedbankUS - Founded in 2000, is a non-profit that sponsors a discount card, the Prescription Plan. It states that "all FDA approved brand and generic prescription medications are covered" and that "everyone can enroll" and benefit from the plan.  They report typical 15% savings on brands and 40% savings on generics.  Their card can be printed online instantly and is free.   
• WisconsinRX, the Wisconsin Prescription Drug Purchasing Coalition is a not-for-profit coalition of employer groups, providing employee discounts, full transparency in pricing and an emphasis on evidence-based research.  In 2006 it expanded to include National CooperativeRx, with large partners in Alaska and Minnnesota and elsewhere. In 2007 it had 230,000 members. For 2007-08 both structures are administered by Caremark, a PBM.

A number of retail pharmacies have established discount plans, with cards or enrollment, for customers or senior citizens. NCSL has not attempted to quantify or describe these other commercial programs.

Regulating Discounts: * Back in 2000-2001 four states, Minnesota (SB 2579), New Hampshire (HB 591), South Dakota (S 88) and Texas (SB 893) enacted laws to regulate or restrict pharmacy discount cards or buyers clubs.

Additional Pharmaceutical Facts, Opinions and Advocacy

• Pharmaceutical Research and Manufacturers of America (PhRMA) - the industry trade association maintains numerous online documents and releases about Rx policies and laws.
• Pharmaceutical Price and Reimbursement Regulation in Europe: by Michael Doodson (former VP of Merck)- National Association of Attorneys General meeting, 1/26/05.
• Prescription Access Litigation Project: As part of Community Catalyst, PAL was created in 2001 to make prescription drugs more affordable for consumers through class action litigation and public education.  PAL has grown quickly and now is a diverse coalition of over 102 organizations, including state-based groups representing 36 states and the District of Columbia as well as several national organizations. 
• Safety Net Hospitals for Pharmaceutical Access (Formerly Public Hospital Pharmacy Coalition) an organization of approximately 400 public and private non-profit hospitals and health systems throughout the U.S. that participate in the Public Health Service 340B drug discount program. 
• ADAP Advocacy Association - seeks the support of advocates, community, health care, government, patients, pharmaceutical companies and other stakeholders to assure that access to services recognize and afford persons living with HIV/AIDS to enjoy a healthy life. 

• Employers Unite in Effort to Curb Prescription Costs -  Rx Collaborative and the PBM industry - New York Times Business section, 2/3/05.

• "Taking Steps to Contain State Drug Costs" - Report #SO70 by California Performance Review, a state executive office, posted 12/04.

• Wyoming: State reopens drug program - The state program to help low-income people afford prescription drugs is open for enrollment again as of July 1, 2006.

• Missouri Rx Compare price web site -  listing local drug store prices. Launched 2006.

• Heinz Family Philanthropies series of studies to determine whether and how states can implement prescription-drug benefit programs. (2002-2005).
  Idaho -- Medicaid Pharmacy Report
  Maine -- Heinz Plan to Overcome Prescription Drug Expenses
  Massachusetts -- Plan for Aggregate Purchasing
  Massachusetts -- Heinz Plan to Overcome Prescription Drug Expenses
  Mississippi -- Heinz Plan to Overcome Prescription Drug Expenses
  Pennsylvania -- Heinz Plan to Overcome Prescription Drug Expenses
  Rhode Island -- Plan for Coordinated Contracting
  Virginia -- Plan for Coordinated Contracting

• Florida Prescription Drug Prices website - "developed by the Florida  Agency for Health Care Administration (AHCA) and the FL Attorney General to help consumers shop for the lowest price in their area for their prescription drugs." Launched 6/05.