Just Say No! ... to high cost prescription drugs

by Athena Godet-Calogeras

Breast cancer is the most common form of cancer in women in the United States, and tamoxifen (sold under the brand name Nolvadex) is the most widely used breast cancer drug for treatment. The drug is typically prescribed for five years in order to prevent the growth and spread of cancer. Data from a report prepared for Rep. Sherrod Brown of Ohio's 13th Congressional District (October 2000) show that uninsured women in his district pay $114 for a month's supply of Nolvadex, In Canada, the same amount of the drug costs $12. That means that a breast cancer patient without prescription drug coverage faces an annual bill of $1, 368 - just for the one prescription.

Meanwhile, in 1999, AstraZeneca, the manufacturer of Nolvadex, enjoyed some $573 million in total sales of the drug.

The above is but one example of a situation that's pandemic in the United States: pharmaceutical companies' profits are soaring making them the most profitable industry in the world, while costs for the uninsured continue to spiral - often beyond their ability to pay.

Drug manufacturers want to keep their profits flowing - and climbing. They do it by:

Lobbying. With one paid lobbyist for almost every 2 members of Congress, the pharmaceutical industry wards off any semblance of price controls. (Rather, since other countries do control prices on the same drugs, cost is shifted to the U.S.)

Manipulating patent laws. By changing dosage, combining drugs, suggesting new uses, companies can get new patents for basically the same drug.

Marketing agressively. Large pharmaceuticals spend 2 ­ 3 times more on advertising and marketing than on research and development.

Negotiating with companies that produce generic versions of the drug. In 1993 AstraZeneca and Barr Laboratories entered into an agreement, allowing Barr to sell a generic version of Nolvadex and paying the company $21 million. Barr, as part of the agreement, dropped a lawsuit against the drug's patent and agreed to sell the unbranded version of tamoxifen, at only a 5 percent discount (even though generic drugs typically cost 30-60 percent less).

That, in short, describes the problem. The solution? Ultimately, a national system that assures everyone comprehensive, quality, and affordable health care. For the present, strong action at the state level. That is where the push for affordable prescription drugs is picking up steam throughout the country. Buoyed by Maine's success in the courts, Ohio now has a similar bill. The Prescription Drug Fair Pricing Act (HB 290; SB 127) has been introduced in the state legislature. (See "Ohio Legislation Highlights" for key features of the bill.)

Ohio legislators of both parties need to hear from their constituents that it's time to say No! to skyrocketing prescription prices and to the outrageous profit of giant pharmaceutical companies) and a strong Yes! to legislation that would make prescription drugs affordable to all Ohioans without prescription drug coverage. It's time to make a bipartisan choice for people's health and well-being over private profit.

Athena Godet-Calogeras is the associate director of UHCAN Ohio.

Rx Action

1. Circulate petitions calling for the Prescription Drug Fair Pricing Act (download them from the UHCAN Ohio website <www.uhcanohio.org>, or call 216/241-8422 or 800/634-4442 for copies).
   
2. Visit your state representative and state senator while they're still on vacation and tell them that Ohioans need affordable prescription drugs. Bring them your prescription drug bills!
   
3. If you're in the Cleveland area, come to a public forum, September 24, 7­9 PM, Catholic Center, 1031 Superior Ave. Hear and talk with Rep. Dale Miller and Sen. Robert Hagan who introduced the legislation (HB 290; SB 127) - and get further involved in actions for affordable prescription drugs.
   
4. Interested in organizing a bus trip to Canada to purchase prescription drugs, and to draw attention to the problem of cost? Call UHCAN Ohio.

Facts to Fuel Rx Reform

• An estimated 2,236,000 Ohioans have no prescription drug coverage.
  
• Ohio is one of 3 states whose residents were given the most prescriptions, 11 per year.
  
• Last year, Ohio residents paid some $4.25 billion to brand name drug companies. If these same drugs were given the Federal Supply Schedule prices (discounted prices given to certain federal agencies), the brand name drug makers would receive payments of $2.7 billion, and Ohio residents would save some $1.54 billion. That is a 36.4% saving.
  
• U.S. residents pay 30-70% more than Canadians and Mexicans for the same prescriptions.
  
• U.S. prescription drug spending rose nearly 17% in 1999 - some $99.6 billion, and analysts predict double-digit increases in spending per year until 2010. In the year 2000, Ohio residents paid some $4.25 billion to brand name drug makers.
  
• Pharmaceutical giants spend two to three times as much on marketing and sales as they do on research and development.
  
• The pharmaceutical industry is earning profits of 18.3% compared to an average profit of 5% for other industries.

UHCAN Ohio and Hospitals Promote Free Care

In an historic collaboration with community representatives, all ten Columbus acute-care hospitals have begun to make significant improvements in promoting free care to uninsured patients. The improvements are described in a new UHCAN Ohio report, "Mending the Safety Net: A Hospital-Community Collaboration Improves Access to Free Care in Columbus," released at a news conference on July 31, 2001 (available on the UHCAN Ohio website).

The news conference, which included free care committee members, hospital representatives, and other community leaders, received substantial coverage in the local media. The Columbus Dispatch also ran a Sunday editorial, "Free and Easier ­ Hospitals work to promote charity care," which stated "Free hospital care for the poor does no good if the poor don't know about it," and acknowledged the efforts of UHCAN Ohio and the hospitals.

The hospitals' efforts came in response to a December 2000 report by UHCAN Ohio, "Holes in the Safety Net" (also available on the UHCAN Ohio website). That report found that hospitals often failed to inform patients about free care programs. Columbus hospitals provide substantial uncompensated care to indigent patients. However, many patients face bills they can't pay. An Ohio law ("HCAP") requires all hospitals to provide and promote the availability of free care (see below). UHCAN Ohio's free care committee challenged the hospitals to collaborate on some immediate improvements and to begin working on larger policy changes.

The hospitals agreed to work with community representatives. Although Columbus hospitals have worked previously with community groups to address unmet health needs, this effort marks a unique hospital-community collaboration on hospital financial policy.

In the first six months of collaboration, each hospital system made immediate improvements in patient outreach and enrollment, including better signs and handouts in English and other languages and staff training on free care.

After a meeting of the four hospital systems called by UHCAN Ohio, all agreed to accept a standard HCAP application, which community-based agencies can use to assist people with bills. In addition, all Columbus hospitals now offer voluntary assistance to patients with incomes up to 200% FPL.

More Work Needed
The hospitals deserve credit for their progress, but more improvements are needed to inform patients and the public about hospital free care. Recommendations include: simple handouts telling patients financial help is available, with a phone number to call; multi-language phone lines to inform and assist non-English speaking patients in applying for assistance; and a community-wide brochure on hospital financial assistance programs.
Hospital free care is not a substitute for comprehensive health care coverage. UHCAN Ohio and the hospitals are working with other stakeholders in Access Health Columbus, a community initiative to create a public/private system that will assure access to appropriate care for uninsured people in Franklin County. The hospital/community improvements in free care will serve as an important building block in creating a local system of care.

UHCAN Ohio offers assistance to community groups in Ohio seeking to improve access to free care at their local hospitals. Contact the Columbus office, (614) 253-4340.

The Hospital Care Assurance Program, or "HCAP"

(Ohio Revised Code, s. 5112.17 and Ohio Administrative Code 5101:3-2-0717) requires all Ohio acute-care hospitals to provide medically necessary hospital care, at no cost, to patients with incomes at or below the Federal Poverty Level ($17,650 for a family of four, in 2001). Columbus hospitals also voluntarily provide free or reduced care to patients with incomes between 101-200% FPL. Both forms of hospital free care do not, however, cover physicians and other non-hospital charges.

For more information on HCAP or hospital financial assistance, check out the UHCAN Ohio website or call the Columbus office, (614) 253-4340.

In Memoriam

Morris Hybloom, a staunch and vocal advocate of universal health care, and our friend, died July 29. He was 87.

Morri was a founding member and long-time board trustee of UHCAN Ohio, and a ready volunteer for projects big and small. If action was needed on an issue, he was there. Morri was never one to leave a petition uncirculated and unsigned, a Letter to the Editor unwritten, a mailing not done, or a comment that money was the crux of the health care problem unsaid. In fact, not a board meeting would pass without Morri reminding us that we wouldn't have health care justice without campaign finance reform.

We will miss him.

Support Federal Health Care for the Uninsured

Legislation to increase access to health care is currently before Congress. Your letters and phone calls to Senator Mike DeWine can expand health care to millions of people.

Senator Max Baucus, Chair of the Finance Committee, has proposed using the $28 billion set aside for expanding health coverage to the uninsured to expand CHIP (Healthy Start in Ohio) to more parents of eligible children. Healthy Start and CHIP currently provide health care to low-income children up to 200% of the federal poverty line in Ohio, pregnant women up to 150% and some very low-income parents. The expansion Baucus proposes would allow states to cover more low-income working parents, pregnant women and legal immigrants as well as make enrollment simpler.

It is urgent that the Senate Finance Committee mark up an uninsured package in September (or else the $28 billion might disappear) and that it include publicly subsidized coverage for these vulnerable groups. A counter Republican proposal would provide health related tax credits, mainly to wealthier (and healthier) persons, most who already have health insurance. Another threat is that the projected surplus could be depleted before the money is spent on the uninsured.

Senator DeWine can play an important part in this expansion. He voted for very similar legislation last year and as a Republican could be influential with Republican members of the Finance Committee. Please write Senator DeWine at 37 West Broad Street, Room 970, Columbus, OH 43215 or call his Columbus office at (614) 469-5186. Thank him for supporting the Family Care Bill last year and urge him to support Senator Baucus' proposal for expansion of coverage to parents, pregnant women and legal immigrants; urge him to urge the Senate Finance Committee to mark up an uninsured package in September that will expand publicly subsidized programs and not tax credits.
Check the UHCAN Ohio website or call our office for updates on this.

Ohio Legislation Highlights

For more information on pending bills, see the legislative summary on UHCAN Ohio's website.
For questions, call Cathy Levine, policy director, at (614) 253-4340 or e-mail her at uhcanohio@ee.net.
Full texts of bills are available on the state's website: www. legislature.state.oh.us.

HB 290 (D. Miller, D-Cleveland); SB 127 (R. Hagan, D-Youngstown) would create the Ohio Prescription Drug Fair Pricing Act. All Ohioans without prescription drug coverage or who are grossly underinsured would be eligible to receive discounts on their prescriptions. The Ohio AFL-CIO estimates savings as high as 50-60%.

Eligible residents (an estimated 2,236,000 Ohioans) would receive a prescription drug card from the Ohio Department of Job and Family Services (ODJFS), which would administer the program.

ODJFS would negotiate rebates from drug companies, as they now do for the state's Medicaid program. Retail pharmacies would be required to pass the discounts onto cardholding consumers. ODJFS would reimburse retail pharmacies for discounts on sales to cardholders.

Any drug company that declined to enter into a rebate agreement would have its drugs subject to prior authorization by ODJFS, under federal Medicaid law.

Rebates paid by the drug companies would be deposited into a special fund. The prescription program under this law would not cost taxpayers anything, because the fund would both reimburse retail pharmacies and cover all administrative costs from the program.

The only obvious downside to the Oho Prescription Drug Fair Pricing Act is that many low-income, uninsured Ohioans cannot afford their prescriptions, even with a 50-60% discount off retail price. However, the program would help many people.

Fighting Pharmaceuticals

"Rarely does the industry go in and propose solutions. They go in and kill or downgrade reform proposals." -- Stephen Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota, on pharmaceutical companies' efforts to stifle state legislation to curb prescription drug prices. (Reported in the National Journal, 7/21/2001)

"We've had a very substantial increase in our state lobbying budget over the last three years," PhRMA President Alan Holmer said, adding, "I think the challenges in the states are very significant." (Reported in the National Journal, 7/21/01)

Are you a UHCAN Ohio member?

Not yet, you say? Please hesitate no longer. Join UHCAN Ohio now and help us work for comprehensive, affordable, and publicly accountable health care for all. We look forward to welcoming you into the UHCAN Ohio family -- and the movement for health care justice!