Fred Dunham of Ellsworth was sitting in his doctor’s office when he noticed a flier asking, “Do you need help paying for your prescription medications?”
He did. Dunham, 57, had been forced to give up his nursing career after being put on oxygen for a progressive lung condition. While he waited for federal disability benefits to kick in, he needed handheld inhalers that cost at least $200 as well as prescription steroids, which caused side effects such as high blood pressure that necessitated even more drugs.
“I can be on sometimes as many as 20 prescriptions at a time,” Dunham said. “It’s extremely costly.”
Two weeks after seeing the notice, Dunham was filling out forms that would save him thousands of dollars over the following two years. Through a program overseen by Ellsworth’s Maine Coast Memorial Hospital, Dunham received one-on-one help to apply for free drugs directly from major pharmaceutical companies.
“I would have been lost without it,” he said.
Since 2005, Maine Coast Memorial has dedicated staff to helping patients navigate the often intimidating maze of paperwork required to apply for drug makers’ “patient assistance programs,” which provide medications at no cost to eligible individuals. Area physicians refer their patients to the hospital for assistance.
During the last fiscal year, Maine Coast Memorial Hospital helped nearly 1,500 patients from Hancock and Washington counties to obtain 5,708 medications. The retail value of those drugs totaled roughly $5.7 million, according to the hospital’s annual report.
The hospital’s help has made the difference for many patients who would have otherwise given up needed medications, said Dr. Kerry Crowley, a Gouldsboro physician who refers about one patient a week to the program.
“The reason I usually send people there is that patients tell me, ‘I cannot afford this medication. I know I need it, but either I’m going to be homeless or I’m going to go without this medication, so I’m going to go without this medication,’” he said.
National studies have shown that up to 40 percent of low-income individuals either fail to fill prescriptions or take less than the recommended dose. Medication “noncompliance” undermines control of chronic diseases such as diabetes and results in more frequent visits to doctors, emergency rooms and hospital inpatient units. It costs the U.S. more than $290 billion each year in avoidable medical spending, according to a 2009 study by the New England Healthcare Institute.
Most major drug makers, including AstraZeneca and GlaxoSmithKline, offer patient assistance programs. While income requirements typically apply, patients don’t necessarily have to be poor or uninsured to qualify, said Dr. Richard Sagall, president of NeedyMeds, a Gloucester, Mass.-based nonprofit that serves as a clearinghouse for medication assistance information.
“It’s not just for indigent people,” Sagall said. “Some of these programs will go up to 400 or 500 percent of the federal poverty level. So for a family of four, that could be $80,000 to $100,000 [annual income]. Nobody would consider them poor, yet they may qualify if they don’t have health insurance or their drug’s not covered.”
The vast majority of drug makers’ patient assistance programs offer drugs at no cost, while a few provide steep discounts, said Sagall, who formerly practiced at Bangor’s Eastern Maine Medical Center.
“I don’t know a number because it’s a closely guarded secret, but it’s billions of dollars worth of drugs every year they give away,” he said.
The programs vary widely. Each drug maker has its own application and decides which medications it will offer, a list then can change periodically based on supplies of drugs and other factors. Each company also sets its own eligibility guidelines — most have an income threshold and require a valid prescription and doctor’s signature.
For patients applying for drugs from multiple companies, the paperwork can prove daunting, especially when each refill triggers a new application. Maine Coast Memorial’s program relieves that burden from patients and doctor’s offices, Crowley said. The program’s staff also stays up to date on which medications are available, he said.
“By the time they send [the forms] to me, all I need to do is to sign them,” Crowley said. “It would be unmanageable, from my perspective, for me to do that or probably even for anyone in my office to do that, because we’re so busy dealing with other forms from drug companies, for prior authorizations, or for appeals to get drugs that patients need. It’s an ever-increasing task.”
Most drugs are mailed to the patient’s home, but some are sent to their doctor’s office. Shipping costs also are often covered.
Crowley said his patients usually get preapproved for a year’s worth of medication at a time. The program has helped patients who lack insurance as well as seniors caught in the Medicare prescription coverage gap known as the “doughnut hole,” he said.
A wide range of drugs is available, from blood pressure and cholesterol medications to drugs for attention deficit hyperactivity disorder, Crowley said.
“You name it and it’s pretty much available for any disease process,” he said.
Insulin, inhalers and cholesterol-lowering statins top the list of drugs that patients receive under Maine Coast Memorial’s program, according to hospital spokeswoman Jane Sanderson.
Some statins can ring up at more than $500 per month at the retail price.
The drug assistance program aligns with the hospital’s mission to improve the health of its community, including preventing unnecessary admissions, Sanderson said.
“As health care evolves, it’s about the total patient,” she said.
Maine Coast Memorial’s program grew out of a 2005 grant to a statewide nonprofit called MedHelp Maine, which sought to standardize services for patients who need prescription assistance. Most doctors have a relationship with their local hospital, making hospitals a convenient hub for such programs, said MedHelp Maine Director Martha Morrison.
Six hospitals took part in the initial grant. Today, at least 14 hospitals from York to Caribou operate some kind of prescription assistance program, according to Morrison.
Hospitals are challenged to dedicate staff to patient assistance programs because government-sponsored insurance doesn’t reimburse them for that service, said Erik Steele, chief medical officer of Eastern Maine Healthcare Systems. But that could change as Medicare and Medicaid continue to move toward rewarding doctors for keeping patients healthy, rather than paying them for each visit and procedure, he said.
“The whole economic equation for what makes sense is changing,” Steele said.
EMHS plans to launch a new pilot program to gather and aggregate data about patients’ medicine use, including cost barriers and side effects, he said. The program will roll out in about six months at one of the system’s primary care practices, he said.
For drug companies, patient assistance programs can prove healthy for their public image. Pharmaceutical companies aren’t mandated to operate the programs, but they receive tax write-offs for giving away drugs and also market their corporate goodwill, said Sagall of NeedyMeds.
“Pharmaceutical companies are really in an odd position,” he said. “It’s really a love-hate relationship — you hate them when you look at the cost of drugs, you love them when their drug saves your life.”
Different companies have different reasons for giving away drugs, Sagall said.
“Many companies do it because they feel that people should take the medicines that they have been prescribed, and if they can’t afford them or they don’t have insurance, they want to help them. So it’s being a good corporate citizen,” he said.
Drug makers are also aware that the programs can encourage patients to grow loyal to a given drug, in hopes that eventually they’ll be able to pay for the medicine, Sagall acknowledged.
As for Dunham, he stopped using Maine Coast Memorial’s program in September. But now he plans to reapply for free medications after seeing his drug co-pays double in January and his premium tick up, he said.
Dunham, who once worked at the hospital, said he found just having someone with his best interests at heart a welcome relief.
“To know there’s somebody out there that’s helping, that’s just fantastic,” he said. “It’s almost as good as a cure, to know someone’s out there caring.”