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Grasping at slippery med costs

Drug money 

Grasping at slippery med costs

Tony Zito had been battling long-term depression when he ran into trouble several months ago. Zito, 57, takes the anti-depressants Prozac and Wellbutrin but doesn't have any health insurance. He was finding that he couldn't afford to pay for his prescriptions, which cost hundreds of dollars a month out of pocket.

"It would be [medications] or groceries," he says. He tried halving his medication doses to save money, but that dropped him into an even deeper depression. He needed his meds, and he needed them cheaply.

That's when he found out about Webster resident Charlie Bell, who operates The Medicine Express, a website dedicated to providing financially strapped people the prescription drugs they need for much less than what local pharmacies charge. Bell immediately took up Zito's cause. "He didn't know what he was going to do," Bell says.

Bell serves dozens of people by locating drug suppliers in Canada and the United Kingdom, where consumer prices are radically cheaper than in the States. Local consumers like Zito then purchase their meds from those foreign providers. The process probably saved Zito's life.

Many critics say vulnerable customers shouldn't be placed in such a precarious position. They say pharmacies charge exorbitant amounts for the most common prescription drugs in order to maximize profits. Says Bell: "It's the biggest hoax they've ever put on people. It's all money, and the politicians and the pharmacies will get richer and richer."

But representatives from major corporate pharmacies dismiss such charges. "That's just not true," says Debbie Parker, Wegmans' director of pharmacy operations. CVS spokesman Mike DeAngelis says his company only reaps a 2- to 3-percent profit from its pharmacy business. "We are not overcharging customers," he says.

True or not, there apparently are enough people who are dissatisfied with the prescription-drug system that numerous consumer-protection efforts have cropped up in the Rochester area. Some of them, like Bell's Medicine Express, are operated by individual citizens. Other movements have the full support of the government --- or at least one section of it.

Miriam Faulkner is a diminutive, soft-spoken senior, but when she discusses her mission, she is unmistakably resolute.

As president of the AARP's Southeast Monroe County chapter, Faulkner has spearheaded the group's partnership with the New York State Attorney General's "AG Rx" program, which has volunteers survey drug prices at selected pharmacies and then posts the prices at www.nyagrx.org.

Faulkner and other members of her AARP chapter are aware of many local residents who lack any health-care coverage and struggle to afford their medication. "That's why we feel strongly about this," she says.

(The AARP has pushed the issue on a national level as well. In April, the organization released its annual report on the cost of prescription medications, announcing an average increase of 7.1 percent in wholesale prices of roughly 275 drugs.)

Under the New York AG program, 31 members of the Southeast Monroe AARP collect prices of 150 popular medications at numerous area pharmacies. State law requires pharmacies to produce, on demand, a list of their prices for those 150 drugs.

While some pharmacies fail to post their lists in public view and others express anxiety about coughing up the information, the vast majority of stores have followed the law. "The pharmacies," Faulkner says, "have been very cooperative."

However, even though many pharmacy reps assert that manufacturing costs are a big reason for the high prices, "the Attorney General feels it's not just the drug companies, but also the pharmacies themselves" who are responsible for the prices, Faulkner says.

We need programs like "AG Rx," says AG spokesman Marc Violette, because the prices of prescription drugs simply aren't regulated. "There is no one in Albany or Washington looking over the shoulder of the pharmacies to keep prices in line," he says. Adds Carlos Rodriguez, an attorney in the AG's Rochester branch: "It's buyer beware."

Without any government regulations on drug costs, consumers are often forced to deal with the ever-increasing price of medication on their own, a fact that Violette says spurred the AG to create the program and website.

"This is a case where the government is not regulating the cost of medications but is giving consumers a chance to make a more informed decision," he says.

So what have the AARP volunteers found? Both Faulkner and Violette say prices often vary greatly from store to store within the same area. Pharmacies as little apart as 10 miles frequently show radical differences in price, even between stores owned by the same company. The New York Public Interest Research Group, which surveyed more than 100 pharmacies across the state earlier this year, found the same thing.

The success of the AG/AARP efforts no doubt influenced state leaders this past summer: Before concluding its June session, the legislature adopted legislation requiring all New York pharmacies to submit their prices for 150 popular drugs to the state Health Department. Governor George Pataki signed the bill in August.

(State officials are unsure how long it will take to collect all the required data and make it public, although the state Health Department must submit a progress report to the legislature by January 31.)

While he wasn't one of the sponsors of that legislation, Assemblymember David Koon, D-Fairport, says he has supported other efforts to address the cost of medications, including an unsuccessful attempt to create a so-called "preferred drug list."

Under the proposal, the state would purchase 30 to 40 high-demand drugs in bulk, then sell them to patients at reduced costs. Koon's also sponsoring legislation that would make fully disabled citizens eligible for the state's EPIC prescription drug program now available to seniors.

While Koon says many state residents need relief from high drug costs and should try to shop around for lower prices, he adds that he isn't aware of any individual pharmacies engaging in price gouging. If such practices were going on, he says, the AG would step in. But at this point, he says, "We haven't found any pharmacies doing that."

Bell is well aware that many politicians receive campaign contributions from the drug industry --- an April report revealed that the Pharmacy Political Action Committee of New York donated nearly $130,000 to state legislators last year, ranking it 16th on a state PAC list --- and he believes such contributions can go a long way in influencing an elected official's votes. "The lobbyists," he says, "run the country as far as pharmaceuticals go."

It's a small part of a huge industry that Bell distrusts intensely, an industry driven by a single motive, he says: "outright, naked greed."

Bell sits in the basement office that has become the headquarters for The Medicine Express. Bell operates the non-profit effort from his modest duplex home in Webster's Summit Knolls development. He doesn't handle any medications himself and doesn't accept any money for his services (any donations he does receive go to Lollypop Farm). A devout churchgoer, Bell calls The Medicine Express his ministry, "my way to serve." He adds: "If they don't have insurance, we're going to help them."

One person helped by Bell is Gary Romano, who sits across a desk from Bell in the Meds-Ex office. Romano, who lives off a pension from a plumbers' union, says he saves thousands of dollars a year with Bell's help. "He's one of the greatest men in the country," Romano says.

The Medicine Express was launched more than three years ago, after Bell found that the meds he takes cost one-third as much in Canada as they do in the U.S. "When that happened," he says, "I said, 'I've got to share this.'"

And recent news that the Canadian government plans to restrict online pharmacies from selling meds to Americans hasn't dampened Bell's spirit; he says he can just find medications in other countries. "People who need medications will still get them," Bell says.

A key component of Bell's operation is his website, www.meds-ex.com, which, like the AG's website, lists the costs of dozens of medications at various local pharmacies. The site then shows how much can be saved a year on each medication by going through The Medicine Express.

Dressed scruffily in blue jeans, brown flannel shirt, and casual brown shoes, Bell later on listens to Tony Zito tell his story over speaker phone. Zito says Bell and The Medicine Express helped give him physical wellness and mental peace of mind. "It takes the pressure off," he says of the service.

Bell sinks into his swivel chair and sighs, then smiles. He says cases like Zito's prove that such efforts are needed --- and that they can work. "How are you not going to feel excited, to feel joyful?" he says of Zito's situation. "If he didn't get that medication, he'd be out of it."

The 69-year-old Bell pauses. "I've made a friend," he says. "I've helped him live."

Critics like Bell acknowledge that pharmacies have a right to make money --- what Bell would call a "sensible profit" --- but industry representatives say there isn't much profit to be made.

John Carlo, Wegmans' director of managed care and product procurement, says that for every dollar his company takes in on prescription drugs, 82 cents are directed back to the production of the drugs. Most of the rest is spent on the pharmacy's operational costs. "The pharmacy only takes 2 cents," he says. "The vast majority goes back to manufacturing costs" like research and development of new drugs.

Such figures match those given by CVS spokesman DeAngelis. "When looking at prescription prices," he says, "the manufacturers set the prices, then pharmacies have to factor in the cost of doing business."

Some of those costs, he says, are the special services CVS provides to customers, such as drive-thru pharmacies and stores that are open 24-7. He also points to the various cost-saving programs the company offers, such as senior discounts and the Extra Care Loyalty Card. In the end, he says, CVS doesn't just charge for drugs, it also charges for such services.

Wegmans' Carlo understands why pharmacies often take the brunt of the criticism from consumers who feel they pay too much for their meds. After all, he says, pharmacies are "the last point of contact" for consumers and therefore (at least in the minds of many customers) the most visible culprits for the high costs. As a result, he says, Wegmans remains sensitive to the issue.

"There's no question such criticisms come back to us," he says. "We feel we provide an extremely critical service to health-care patients. We're very concerned with the costs of drugs."

But for the millions of people who struggle to afford the drugs they need to survive, simple corporate concern doesn't go far enough. That's why citizens like Charlie Bell and Miriam Faulkner decided to put their concern into action. And, judging from the state's recent actions, activists like them seem to be making a difference.

To learn more about The Medicine Express, visit www.meds-ex.com.

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