Affordable drugs are priority for legislators
By Lynda Arakawa
Advertiser Capitol Bureau
Stanley Samson spends about $500 a month on prescription drugs and goes without other medicines because he can't afford it. In addition to his disability after a car accident, he suffers from several chronic health problems, including diabetes, a heart condition, asthma and arthritis.
"I need medication, and yet it's out of reach," said Samson, a 53-year-old Mililani resident. "I'm not taking everything I need because I can't afford it."
Samson is among the estimated 300,000 Hawai'i residents who do not have prescription drug coverage. His case and others are spurring legislation circulating in the State Capitol as lawmakers try to make prescription drugs more affordable.
During this legislative session, there has been a noticeable increase in bills aimed at making prescription drugs more affordable, with bills ranging from making generic drugs available here more quickly to improving a law that establishes a state prescription discount program. Lawmakers also have considered establishing refundable tax credits and even paving the way for the state to import less expensive drugs from Canada.
The proliferation of these measures partly reflects the understanding of elected state officials that prescription drug costs are a major budget issue for the state, said Greg Marchildon, state director of Hawai'i AARP, which advocates on behalf of retirees.
"I think the second thing that's happening here is that this is a politically potent issue," he said. "This is a pocketbook issue that people just innately understand ... and they want someone to do something about it."
Sacrifices necessary
Among those seeking relief from the Legislature is Moloka'i resident Susan Goodhue. Her 51-year-old husband, Edward Kekuhi Goodhue, spends $286 a month on prescription drugs to control his epilepsy. That expense means their family of four has had to make sacrifices.
"It's really tight to buy groceries," Susan Goodhue said. "We can never go to a movie anymore. That's out of the question.
"This is an issue that hits old, young and in-between. This is not just an elderly issue. It's an issue of vital importance to every single person."
One measure that appears to have garnered support is an administration bill that would streamline the process to make generic drugs available here.
Another that seems to have the most political momentum, and would have the most impact, is legislation that would fine-tune a law scheduled to take effect in July. The law aims to reduce costs by creating a state purchasing pool to buy medicine at discounted prices and pass the savings on to consumers.
Senate Bill 3237 and House Bill 2005 would change the law by restricting the state program, dubbed Hawai'i Rx Plus, to people who earn no more than 3 1/2 times the federal poverty level. In Hawai'i, that would be about $75,880 for a family of four and $37,450 for a single person.
It also would include people whose out-of-pocket prescription drug expenses equal at least 5 percent of their family income or whose total out-of-pocket medical costs equal at least 15 percent of family income.
Two-step program
The program will be carried out in two steps. Beginning July 1, eligible residents would be given a discount card that would entitle them to Medicaid discounts on prescription drugs at participating pharmacies. That would save the uninsured anywhere from 15 percent to 60 percent, said the AARP's Marchildon, who has been closely involved in the legislation.
In the second part of the program, to begin in July 2005, the state, using the number of participants as leverage in a purchasing pool, will negotiate supplemental rebates with drug manufacturers and pass the additional savings to consumers.
Gov. Linda Lingle has indicated support for fine-tuning the law, and her administration has been working with lawmakers on the legislation.
The Pharmaceutical Research and Manufacturers of America, however, likened the Hawai'i Rx Plus program to government-mandated price controls that will ultimately jeopardize the health of patients by discouraging innovation.
"Of all U.S. industries, the pharmaceutical industry reinvests the largest share of its revenues back into research and development," the organization said in a written statement to House committees considering the measure earlier this month.
"With such commitment to innovation, the pharmaceutical industry can continue to bring new medicines to market to prevent, cure and better treat disease."
Frustration mounting
But it's clear many people need relief from the high cost of these drugs soon. Hawai'i Kai resident Marge Cricchio and her husband, Guy, frustrated with paying hundreds of dollars a month for medicine, have begun ordering their prescription drugs from Canada at lower prices. Marge, 69, takes four different eye drops for glaucoma, while 75-year-old Guy takes Celebrex for Paget's disease, a chronic bone disorder.
The Cricchios, who ran a business in Long Island before retiring here, have health insurance but no prescription drug coverage. But like many people, medicine is an unavoidable expense for them, not an option.
"You have to have them," Marge Cricchio said. "If I don't have it for glaucoma, I'd be going blind, let's put it that way. So you put that first, above other things that you want to do."
Cricchio said her husband tried going without Celebrex for a while because of its high out-of-pocket cost — $175 for 30 pills — "but he just couldn't do it."
Mindi Munar, a 24-year-old graduate student without health insurance, said she got sick a few months ago when she tried doing without her prescribed antidepressants because it cost too much. She now receives samples from her doctor, but also has had to shell out about $100 for antibiotics in each of the couple of times she was sick last year.
Munar considers herself lucky because she doesn't get sick often and has been able to afford medicine when she does. But knowing she has to pay the total cost of medicine out of her own pocket is stressful.
"The most uncomfortable thought is knowing that you don't have coverage and anticipating the what if," she said. "What if I get sick and I need to go and get medicine? We always have to brace ourselves and give ourselves a cushion. And luckily we are able to do that. Some people don't have the resources to keep funds on the side."
Reach Lynda Arakawa at larakawa@honoluluadvertiser.com or 525-8070.
