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Making Medicines Affordable.



A number of states have for years helped older Americans buy needed prescription drugs prescription drug Prescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug, .

When Margaret Gallagher, 77, goes to the drug store each month, she makes a choice--to buy her cardiac medicine or her anti-arthritis drugs. Her doctor used to help by providing no-cost samples, but they are no longer available.

Margaret's story is repeated daily in communities across the nation. Prescription drugs make up only 11 percent of the total of all health care costs, but that statistic statistic,
n a value or number that describes a series of quantitative observations or measures; a value calculated from a sample.


statistic

a numerical value calculated from a number of observations in order to summarize them.
 is no comfort to many patients. There are several real-life obstacles. First, Medicare and some private health insurance plans do not cover prescription drugs. Second, health plans that do cover drugs often have restrictive formularies or lists that exclude coverage for a particular drug. Third, spending for prescriptions was increasing an average of 16 percent in 1999, significantly higher than other major medical expenses.

It is no surprise that President Clinton and some members of Congress are calling for federal drug benefits. Yet senior pharmacy assistance programs have been in place in several states for as long as 25 years--quietly but effectively filling a critical gap for moderate-income seniors and others. Using creative combinations of state funds and public-private partnerships Public-private partnership (PPP) describes a government service or private business venture which is funded and operated through a partnership of government and one or more private sector companies. These schemes are sometimes referred to as PPP or P3. , these programs now are pointing the way for other states, as well as for federal policymakers.

As of mid-1999, 16 states had created pharmacy assistance programs with several common features. Eligibility is based on annual income limits (typically between $14,000 and $19,000 for a single person); the minimum age often is 65 (eight states include special coverage for adults under 65 with disabilities). The programs vary significantly in overall size. In New Jersey, some 206,000 people received help from its program, which marks its 25th year in 1999. The Michigan Emergency Pharmaceutical Program, founded in 1988, serves 31,000 residents.

Three states use earmarked funds: Massachusetts uses a portion of a 25-cent a pack cigarette tax; New Jersey earmarks casino revenues; Pennsylvania uses lottery proceeds. Several others depend on special trust funds. To avoid runaway state costs, most programs have some form of limitations or cost sharing:

* Connecticut has a $12 copayment co·pay·ment
n.
A fixed fee that subscribers to a medical plan must pay for their use of specific medical services covered by the plan.


copayment,
n
 per prescription.

* Illinois requires the first $15 per month be paid by the patient.

* Maryland covers only chronic maintenance and anti-infection drugs.

* Massachusetts has a $15 annual enrollment fee and a maximum annual benefit of $750.

* Minnesota's participants must meet a $300 annual deductible That which may be taken away or subtracted. In taxation, an item that may be subtracted from gross income or adjusted gross income in determining taxable income (e.g., interest expenses, charitable contributions, certain taxes). .

Unlike Medicaid, most state programs are not entitlements. For example, Minnesota's 1999 law states "new enrollment shall cease if costs of the program ... will exceed appropriated funds." In a bid for federal involvement, that same law specifies, "This section shall be repealed upon federal approval of the waiver The voluntary surrender of a known right; conduct supporting an inference that a particular right has been relinquished.

The term waiver is used in many legal contexts.
 to allow the [Minnesota] commissioner to provide prescription drug coverage for qualified Medicare beneficiaries. ..."

Connecticut appropriated $29 million for FY 1999 to serve about 37,700 residents, an average cost of $775 per recipient.

The Maine Legislature The Maine Legislature is the state legislature of the U.S. state of Maine. It is a bicameral body composed of the lower house Maine House of Representatives and the upper house Maine Senate. The Legislature convenes at the State House in Augusta, where it has met since 1832.  significantly expanded its program this year, raising allowable income levels and expanding the list of drugs covered.

Senator Judy Paradis is co-chair of the Maine Health and Human Services Noun 1. Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Department of Health and Human Services, HHS
 Committee and lead sponsor of the 1999 expansion. "It's a no brainer," she explained. "By providing a drug program that is very inexpensive per person, we are able to maintain people in their own homes and not use high-cost acute care hospitals or long-term care long-term care (LTC),
n the provision of medical, social, and personal care services on a recurring or continuing basis to persons with chronic physical or mental disorders.
. People had been discouraged because our program income limits had been very low, but now thousands of additional elders are eligible."

Next year, Maine legislators plan to designate des·ig·nate  
tr.v. des·ig·nat·ed, des·ig·nat·ing, des·ig·nates
1. To indicate or specify; point out.

2. To give a name or title to; characterize.

3.
 tobacco settlement money to pay for a further expansion.

Missouri used a different approach, establishing a state income tax credit up to $750 per year for pharmaceutical costs incurred by qualified seniors and disabled veterans.

The American Association of Retired Persons American Association of Retired Persons: see AARP.  (AARP AARP, a nonprofit, nonpartisan national organization dedicated to "enriching the experience of aging"; membership is open to people age 50 or older. Founded in 1958 by Ethel Percy Andrus as American Association of Retired Persons, AARP now has over 30 million ) views these programs as helpful. "State officials recognize that many people who are not eligible for Medicaid have severe problems paying for prescriptions. Many older Americans are endangering their health because they cannot afford their drugs, or they are forced to choose between crucial drugs and the other necessities of life," notes David Gross David Jonathan Gross (born February 19, 1941 in Washington, D.C.) is an American particle physicist and string theorist (although he's stated to the Brazilian newspaper Folha de São Paulo, on 09/27/2006, that the second area is included in the first one).  of AARP's Public Policy Institute.

The pharmaceutical industry has mixed views on state-run programs. Individual drug manufacturers donated $500 million worth of pharmaceuticals through doctors in 1998, but there is little coordination of distribution and no guarantee that a specific product is available. The industry supports low-income assistance programs, but opposes broad legislation that mandates price discounts or lower reimbursement Reimbursement

Payment made to someone for out-of-pocket expenses has incurred.
 rates.

Whether Congress decides to expand Medicare to cover prescription drugs or not, states are likely to remain actively involved in pharmacy assistance.

Richard Cauchi is a policy specialist with NCSL's Health Care Program in Denver.
                       PHARMACY ASSISTANCE PROGRAMS
State          Year started      Recipients
Connecticut        '86         [37,700.sup.*]
Delaware         '81 &'99      [9,600.sup.*]
Illinois           '85         [53,555.sup.*]
Maine            '75 &'99      [24,000.sup.*]
Maryland           '79         [21,400.sup.*]
Massachusetts      '96             26,000
Michigan        '88 & '94          31,000
Minnesota          '97           4,500 est.
Nevada             '99      Not yet in operation
New Jersey         '75        [205,900.sup.*]
New York           '87             99,500
North Carolina     '99      Not yet in operation
Pennsylvania       '84            239,000
Rhode Island       '85             27,000
Vermont            '89         [10,500.sup.*]
Wyoming            '88          [550.sup.*]
Includes disabled
Recipient enrollment figures are as of 1997-98 and
do not reflect 1999 expansions.
Sources: NCSL state research; AARP; National
Pharmaceutical Council


CALIFORNIA SENIORS TO GET MEDICATION DISCOUNTS

California took a new approach in October to help older residents buy medications. Senate Bill 393 requires that pharmacies participating in the Medicaid program (Medi-Cal) also offer a discount price to all Medicare beneficiaries. The price "shall not exceed the Medi-Cal reimbursement rate for prescription medicines" plus a small processing cost.

The law is aimed at those over age 65, who make up 12 percent of the state's population, but use 33 percent of the drugs sold, according to according to
prep.
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

3.
 its lead sponsor Senator Jackie Speier Jackie Speier is a former Democratic member of the California State Senate who represented parts of San Francisco and San Mateo Counties. Early life
Speier was born May 14, 1950 in San Francisco, California. She earned a B.A.
.

"Retail prices for seniors without drug coverage are far more, often double, than the prices that drug companies charge their most favored customers, such as government agencies and HMOs," she says. "On average, the savings to seniors would be 20 percent to 40 percent. What makes this law unique is its simplicity and lack of complicated bureaucracy. There is no means test--you show your card and get a discount."

Unlike other states' subsidy subsidy, financial assistance granted by a government or philanthropic foundation to a person or association for the purpose of promoting an enterprise considered beneficial to the public welfare.  programs, there is no direct cost to the taxpayers; the California Department of Health Services Department of Health Services may refer to:
  • Los Angeles County Department of Health Services
  • California Department of Health Services a California state agency
 simply is required "to transmit the price to the pharmacy." The law does not alter other aspects of the federally regulated Medicare program.

Interestingly, the California Pharmacists This is a list of notable pharmacists.
  • Dora Akunyili, Director General of National Agency for Food and Drug Administration and Control of Nigeria
  • Charles Alderton (1857 - 1941), American inventor the soft drink Dr Pepper
  • George F.
 Association, which remained neutral as the bill worked its way through the Legislature, commended Senator Speier after the law was signed. Carlo Michelotti, the association's chief executive officer, said the law "will level the playing field for Medicare patients' medication costs and ensure continuity of care by encouraging seniors to use community pharmacies" instead of mail-order pharmacies. However, there still is concern that pharmacies in some areas could withdraw from serving Medicaid.

The California law California Law consists of 29 codes, covering various subject areas, the State Constitution and Statutes. See also
  • Statute
  • Bill (proposed law)
  • California State Legislature
External links
  • http://www.leginfo.ca.
 will go into effect next month and will expire in three years unless it is extended.
COPYRIGHT 1999 National Conference of State Legislatures
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1999, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Author:Cauchi, Richard
Publication:State Legislatures
Article Type:Statistical Data Included
Date:Dec 1, 1999
Words:1188
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