Curbed access / A drug advisory
may hurt Medicare recipients

Pittsburgh Post-Gazette, Friday, January 27, 2006

The new Medicare drug benefit has been a prescription for confusion for millions of older people who must choose coverage from a complex variety of plans -- each with different benefits, premiums, deductibles and pros and cons.

The new benefit is also having an unforeseen side effect that could block access to prescription drugs for many low-income Medicare patients. Among them are seniors who don't sign up for coverage and individuals who choose an inexpensive prescription drug plan, where benefits lapse after reaching a limit of $2,250 annually.

ow-income senior citizens long have benefited from drug company programs that give free or discounted drugs to low-income people. Glaxo-SmithKline, for instance, pioneered one such "patient assistance program," an effort called Bridges to Access.

PAPs are among the pharmaceutical industry's notable expressions of social consciousness, which the public often overlooks in its preoccupation with drug pricing. Industry giants like GlaxoSmithKline, AstraZeneca and Eli Lilly reportedly plan to end their patient assistance programs.

The problem is the drug industry's reading of guidance from the Inspector General's Office in the Department of Health and Human Services, which runs Medicare. Drug company assistance programs that subsidize Medicare patients may violate federal laws barring kickbacks, HHS said. PAPs could be interpreted as efforts to steer patients to the manufacturer's own brand-name drugs, rather than less-expensive generic drugs.

That reasoning is specious and sophistic, at best. Where's the kickback, the big bucks to pocket, when a drug company provides free or minimal-cost medicine?

HHS and the pharmaceutical industry should work together on a compromise. If that fails, it's up to Congress, which did not intend this new health benefit to hurt low-income Medicare patients.