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How Big Pharma Bilks the Elderly

The Real Drug Culture

by MICHAEL DONNELLY

Usually it goes right in the recycling. But, this letter from AARP got my attention. It announced a workshop titled, "Reduce Your Prescription Drug Costs in Three Easy Steps."

AARP reports the astonishing fact that in 2002, over 75% of Americans age 45+ take an average of four prescription drugs per day. I’m 55 and do not use any prescription drugs. Even though I’m the one in four that does not, I am also the trustee and general caretaker for my 88-year-old in-laws. They have a laundry list of medical conditions and the concomitant list of medications. My father-in-law’s monthly medication bill alone has approached $1000 at times. Since he is a retired Colonel and a stock market expert (before dementia set in), the resources are there for us.

But, as I read the invite, I kept being shocked awake on an issue I hadn’t really thought of much before. What do the majority of poor elderly do, anyway? Paying for their prescriptions was a problem for 71% of people over 65, according to the AARP survey. In Oregon, the state health plan spent some $288 million on prescription drugs in the 2001-2003 biennium, compared to $189 million in 1999-2001. This was for people not covered by regular insurance. It comes out of general tax revenues. And, even if you have insurance, it means higher premiums.

My friends and I like to joke about all the "Jerry Garcia Memorial Retirement Centers" that will be springing up in the next couple decades. (Actually, we take it quite seriously because of the potential environmental impacts.) But, all this AARP info came as a reality check on just what that future might really entail. So, I decided to go to the workshop and find out what was up.

Some of it was obvious, like the fact that older people are more likely to use prescription drugs than younger people; some not as obvious, such as women are more likely to use prescription medications than men.

Twenty-five per cent of folks have not filled a doctor’s prescription in the past two years due to cost. And, many have stopped taking prescriptions due to side effects or finding no measurable effect at all.

Over a third of folks don’t even tell their physicians about all the medications they take; and far less than that ask for generic meds. In fact, a quarter responded that they think that generics are of poorer quality and over 40 per cent think generics are "less effective." Yet, AARP has released a study showing that, as the baby boomers enter the age of daily users, prescription drug prices have consistently increased at a rate over three times that of inflation — from an increase of 4.1% in 2000 to one of 6.9% in 2003. Inflation actually decreased from 2.3% to 2.0% in 2003.

Medicare "Improvement"

On December 8, 2003, President George W. Bush signed into law the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003. Democrat Senate stalwarts Leahy, Murray, Cantwell, Feingold, Boxer, Feinstein, Daschle, Wyden, Schumer, Biden, Reid, Baucus, Kennedy…joined the Republicans and voted FOR MMA. A handful of Senate Democrats opposed MMA, including Clinton, Byrd, Harkin, Levin and John Edwards. John Kerry was a no show and did not even make his position known, as he has also failed to do on most impacting legislation the past two years.

Here’s how it "works":

If all one has is Medicare — the nation’s health care system for people over 65 and some younger folks with disabilities–you must pay for the first $250 dollars of medications per year. After that 25% of drug costs, up to $2250 total, are borne by the user–a cost of over $500.

Then it really gets arcane. From $2250 up to $5100, the person pays it all–which means up to $3600 out-of-pocket on that $5100 total. Over $5100 is considered a "Catastrophic Benefit" and one "only" has to pay 5% out-of-pocket on top of the original $3600.

Then there is something called a Medicare-approved Drug Discount Card–err, make that "cards." Part of the 2003 legislation was that drug manufacturers could issue their own discount cards. Yet, here’s the kicker: one has to choose their card from among many BEFORE one knows just what the discount is OR just what drugs it covers. And, once the blind choice is made, there is no option for reconsideration. You can only have one Medicare-approved card at a time. You won’t even know in advance if your pharmacy even accepts the card! And, the drug companies can change what drugs are covered, and the price, on a weekly basis. Las Vegas should have it so easy.

To top it off, even if one figures it out and gets properly enrolled with the right card (48% admit they cannot begin to figure it out); the discount card program ends in January 2006. Then, a new program called the Medicare Drug Benefit (Part D) kicks in, requiring another round of trying to figure out what’s gong on, how to enroll, what drugs are covered–things the many users of these drugs are limited in doing in the first place.

Educating Consumers

We all saw the shocking events at the Super Bowl — no, not Janet’s adorned boob — the endless ads for Cialis, Viagra and Levitra. The makers of these sexual performance drugs collectively spent over $265 million to advertise them in just the first five months of this year alone; something the companies disingenuously call "educating consumers."

(Consumers would be better off being educated about the risk of sudden cadiac arrest that has been noted in the erectile enhancement drug’s standard doasge use. In an analysis of 1,473 major adverse events recorded in reports about Viagra to the FDA, 522 people died, most of them from cardiovascular causes.)

On top of this, in the same five months, Bristol-Myers Squibb shelled out $35 million to promote (er, educate) Plavix, a blood thinner. The price of Plavix rose over 7.9% during the same time period. The company also spent $7.2 million to promote Pravachol, a cholesterol-lowering drug. That one rose in price by 7%. Merck spent $24 million to advertise another cholesterol drug, Zocor, which has risen in price by 26% since 1999. It’s the same across the board: the number one med used by people over 50 is Fosamax (Merck)–up 4.9% since last year–ad budget a modest $12 million. Number two Lipitor (Pfizer) is up 4.6% on an ad budget of $67 million. Plavix (number three) is up that 7.9%. And, so on down the line.

Those Three "Easy" Steps

AARP was in total collusion with Big Pharma in the run up to the Medicare Prescription Drug, Improvement and Modernization Act. AARP even has its own Discount Card in the mix.

Though I got quite an education in the predatory nature of Big Pharma, in the end I did not get much help and I’m sure from the questions that most of the older folks at the seminar were thoroughly confused.

In the end, all AARP could offer was this (the vaunted three easy steps):

Ask your Doctor and Pharmacist:

1) Is there more than one prescription drug that can be used to treat my condition?

2) If so, how do they compare in safety and effectiveness?

3) How do they compare in cost?

There you have it. Armed with such stellar advice we can all look forward to aging gracefully in modernized Medicare America. Just make sure you have the right card.

Don’t get me wrong. Generics ARE the way to go. Anone can see that. recently the quinolone antibiotic Cipro (ciprofloxacin hydrochloride). Bayer AG’s drug is most used for Inhalation Anthrax, but also used for some tough cases such as hospital acquired pneumonia and urinary tract infections, was selling for over $250 per prescription. Just a few weeks ago, the generic version became available for just $5–a savings of 5000%.

A Tardy Congressional Response

Some in Congress are already coming to their senses, perhaps bothered by their 2003 MMA giveaway to companies that prey on the elderly and infirm. S. 2328 has been introduced, sponsored by Senators Dorgan (D-ND) and Snowe (R-ME). This bill, co-sponsored by Senators McCain, Clinton, Lott and Stabenow, would allow consumers to buy their prescription drugs from Canada. Of course, people already do this and Big Pharma has taken note and is restricting supplies to Canadian pharmacies which have drug prices controlled by the government.

Ultimately, Congress will have to also institute price controls in order to take on the voracious practices of Big Pharma and do something as millions age. I await the day when legions, who came of age in the 60s, mount Capitol Hill in wheelchairs and walkers. Taking on this wing of conscienceless capitalism will be perhaps the final, and most personal, life and death issue the Baby Boomers will face.

MICHAEL DONNELLY lives in Salem, OR where he cares for his in-laws. His father-in-law flew 25 daytime bombing missions over Germany in W.W.II. He is a contributor to CounterPunch’s new book on the 2004 elections, A Dime’s Worth of Difference. He can be reached at pahtoo@aol.com