ANNAPOLIS – Pearl Lewis made $32,000 last year, but spent $15,000 on prescription drugs.
While Lewis is a Medicare beneficiary, her income is above the $9,650 yearly cap on eligibility for Maryland’s Pharmacy Assistance Program. She borrows money from relatives to pay for medication.
Lewis, 56, a volunteer patient advocate, is not alone in her struggle to pay for prescription drugs, an expense that keeps rising. That’s why she supports Maryland’s House Bill 6. The bill, filed in November, proposes establishing the Maryland Pharmacy Discount Program and the Maryland Medbank Program. Both programs would provide discounted and free medicines to those eligible.
However, Maryland state officials are considering passing price control legislation, discounting Medicaid prices for Medicare beneficiaries and expanding the state’s current programs in an attempt to tackle the prescription drug coverage issue.
“The cost of drugs has gone higher and higher,” said Lewis. “Even older drugs that have been on the market for a long time are going up 20-30 percent.” Lewis said she knows of many patients who are admitted to the hospital, take drugs there, get better, return home and then can’t afford to fill the prescriptions. They end up back in the hospital.
“The only place you get your drugs is in the hospital,” she said. “It’s a revolving door.”
Those are the kinds of situations that legislators and state officials are trying to mitigate.
The goal, said Debbie Chang, deputy secretary of health care financing at the Department of Health and Mental Hygiene, is to develop a game plan that will keep up the state’s current programs of providing prescription drug coverage at the “best price.”
The department also wants to identify ways to expand prescription drug coverage to other populations.
Drug spending in the nation grew more rapidly than other health spending in the 90s, according to a 2000 report from the U.S. Department of Health and Human Services. Nationwide, 23 percent of Americans under age 65 do not have prescription drug coverage and 31 percent of Medicare recipients receive no assistance for medication.
Marylanders spent 22.2 percent more on prescription drugs in 1999, according to a report by the Maryland Healthcare Commission.
Even with coverage, Chang said, many people are underinsured for prescription drugs because some plans require premiums, deductibles, and co- payments and prescription drug benefits are often capped.
Those providing health care agree pharmacy costs are too high.
“My client believes that these increasing costs of prescription drugs are a serious problem,” said Robert Enten, a lobbyist for Maryland Association of Health Care Plans.
“There aren’t any fast and easy solutions. I think it’s something the Legislature is going to have to take a hard look at,” he said.
The Department of Health and Mental Hygiene uses seven main methods to control rising pharmacy costs. They require prior authorization when a prescription exceeds $400 and physician justification when a patient is not allowed to use a generic alternative. Additionally, the department analyzes “brand medically necessary” prescriptions.
“We do prior authorization so there’s another level of people looking at whether the drug is necessary,” Chang said.
So far, Maine is the only state to have passed price control legislation. In California, Vermont, Maine and Florida, Medicare recipients pay discounted Medicaid prices for prescriptions.
Chang told the Budget and Taxation Committee at a hearing this week that the Department of Health and Mental Hygiene is monitoring other states closely to see how effective these strategies are.
“We’re going to closely watch this on the federal level,” she said. “We’re working with everybody on this issue.”
The Budget and Taxation Committee plans further discussions with the department, said Sen. Barbara Hoffman, chairwoman and a Baltimore Democrat: “We have to be innovative and figure out how to help you.”
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