US patient assistance programs under review

Drug firms supplying the US market are reviewing their patient assistance programs in view of the introduction of the Medicare prescription drug benefit (see page 13 this issue). The relevance of the programs, which enable low-income patients to receive reduced-price drugs, is questioned when the government program provides for almost universal coverage for senior citizens.

One reason for maintaining some form of PAP is the appearance of the "Donut Hole," the gap between the first $2,250 and $5,100. In this range of drug costs, Medicare beneficiaries are expected to cover these themselves, before "catastrophic care coverage" kicks in. One problem is that, unlike financial assistance from family and friends, grants from charities and subsidies from State Pharmacy Assistance Programs, drug company help does not count towards the $5,100 threshold. This means that drug firms offering PAPs could be expected to provide aid indefinitely, once a patient has reached $2,250, who in turn is denied coverage for any other drugs until the catastrophic relief threshold has been reached for those drugs only.

Faced with this scenario, some drugmakers have already ceased to operate their PAPs, including Israel-based generic giant Teva Pharmaceuticals. Two US Senators representing both parties in Congress, Charles Grassley and Max Baucus, invited representatives from US drugmakers Eli Lilly and Johnson & Johnson, UK giant GlaxoSmithKline and Anglo-Swedish major AstraZeneca to discuss the future of PAPs. All four firms confirmed that they would continue patient assistance in some form for low-income Americans. Two other US drug firms, that did not attend the meeting, also confirmed that they would not be ceasing their PAPs: Merck & Co and Schering-Plough.