Drug Costs and Safety Questioned

By Kleyman, Paul | Aging Today, January/February 2004 | Go to article overview

Drug Costs and Safety Questioned


Kleyman, Paul, Aging Today


It is a "myth" that "the elderly struggle to pay for their prescription drugs." Furthermore, "according to recent estimates, 68% of seniors spend less than $1,000 in out-of-pocket costs for prescriptions. Fifteen percent spend between $1,000 and $2,000." Of the other 17% who have soaring direct charges for prescription drugs, "Congress should have set aside funds to help that small group only" instead of giving middle-class retirees a new benefit, which will one day "bankrupt your grandchildren." That $400 billion could have helped the 43 million uninsured Americans, many of them poor children.

That view, held by many conservatives, was stated by Cynthia Tucker, editorial page editor of the Atlanta Journal-Constitution, in a nationally syndicated column headlined "Prescription Drug Plan Boondoggle." Thomas S. Bodenheimer of the Department of Family and Community Medicine at the University of California, San Francisco (UCSF) might agree with the term boondoggle, but his presentation at the American Public Health Association (APHA) conference in San Francisco in November suggested a very different perspective from Tucker's-one with sources thoroughly documented, unlike the columnist's "recent estimates."

In a presentation titled "Is the Level of U.S. Spending on Medical Care Inappropriate? The case of Prescription Drugs," Bodenheimer reviewed recent literature, an analysis that raised disturbing questions about the reasonableness of the present U.S. approach to the pricing, availability-and safety-of pharmaceuticals.

OVER IO MILLION

Bodenheimer cited a Kaiser Family Foundation (KFF) study released in 2001, "Targeting Medicare Drug Benefits," which showed that about one in four of the approximately 35 million older Medicare beneficiaries (over 10 million people) have annual incomes under 150% of the federal poverty line, or about $12,500, and almost 4 million of them have no drug coverage. These elders, who endure such illnesses as diabetes, hypertension and heart disease, typically spend $2,500 per year out of pocket, Bodenheimer said, or 20% of their income, on Medicare prescription drugs.

The KFF study also showed that in 2001 approximately 8 million Medicare beneficiaries spent over $1,100 on prescription drugs. Two million Medicare beneficiaries spend at least 10% of their annual income on prescription drugs, the study showed.

Bodenheimer-whose essay in the Oct. ? o, 2001, issue of the Journal of the American Medical Association (JAMA) raised serious concerns about the lack of affordable prescription drugs in the United States-cited another article from the same issue of JAMA during his APHA presentation. The study by A. D. Federman and colleagues revealed that among Medicare beneficiaries with coronary heart disease, over 25% of those with pharmaceutical coverage were taking statin drugs to lower their cholesterol, compared with only 4% of those who lacked drug policies. Also, Bodenheimer said that a study of out-of-pocket costs borne by Medicare beneficiaries with hypertension by Jan Blustein (Health Affairs, March-April, 2000) showed that "Medicare beneficiaries with high blood pressure who do not have drug coverage are 40% less likely to purchase their drugs than those with coverage."

Bodenheimer examined published research and reporting on fast-rising prescription drug prices in the United States. Forexample, The NewYorkTimes (May 8, 2001) reported that prescription drug prices rose 19% in 2000, and 36% ofthat increase "was due to a shift in prescribing, from less expensive to more expensive drugs," Bodenheimer said. he added that an analysis in 2002 by the National Institute for Health Care Management showed that "only 15% of drugs approved by FDA [the U.S. Food and Drug Administration] between 1989 and 2000 were significantly better than already-existing drugs."

A study of prescription drug trends issued by KFF in 2000 showed that in 1998, the io largest drug companies spent 11 % of their revenues on research and development and 26% on manufacturing pharmaceuticals. …

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