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Days after California voters rejected two ballot initiatives that competed in an effort to create statewide drug discount programs, Medpin director Kathryn Saenz Duke, JD, MPH, wrote the following op-ed recommending ways for the drug industry to help vulnerable patients afford their medications. This commentary was published in the San Francisco Chronicle on November 11, 2005.

"Free Enterprise" Help for the Uninsured

The drug industry is surely celebrating California voters' decision to reject both of the special election's drug discount measures this week. It poured $80 million into this state election, and its trade association noted that a major motivation was to "preserve the free enterprise system"-presumably one in which companies are free to decide how much and in what ways to help low-income people who cannot afford the retail price of their medications.

Is the drug industry now ready to invest another $80 million in our state-this time on activities that help vulnerable Californians instead of campaign consultants? Here are a few steps these companies can take to truly help uninsured and underinsured patients.

Assess and improve their charitable programs, instead of merely promoting them. Medicine for People in Need (Medpin), a project of the nonprofit Public Health Institute, operated a three-year program that distributed $170 million worth of medications to uninsured Californians. This program was transparent, predictable, and consistent-the very features that nonprofits have for years requested from the drug companies' charitable programs. The industry should build on lessons learned from this effort to make its charitable programs more accessible and valuable to needy patients and their health care providers.

Agree to report verifiable data that provides specific information on how companies' charitable programs actually help people. This is especially important for California, because evidence suggests that our uninsured residents are less likely than other states' to be helped by companies' free-drug programs.

Adjust to the realities of the new Medicare drug coverage. Many drug companies are preparing to end or curtail their charitable programs for Medicare patients. Unless these companies work with independent nonprofits to ensure that their programs complement Medicare's new prescription drug coverage, many elderly, blind, and disabled patients will be seriously disadvantaged when Medicare drug coverage begins.

Support evidence-based assessments of newly approved drugs. Ironically, many low-income patients with chronic conditions are treated with high-priced new drugs, courtesy of the industry's charitable programs and the free samples distributed to providers. This may work well as long as the samples and charity lasts, but once a company's marketing campaign ends (along with its free samples) and its voluntary charity is curtailed, what happens to those patients? Drug companies should support efforts by Medicaid agencies and health care providers to stabilize low-income patients from the outset on medicines selected through an evidence-based process to be the best and most cost-effective.

Drug companies must answer to different and sometimes competing priorities, including a responsibility to shareholder profits and a moral commitment to sustain charitable programs. The industry is both a beneficiary of government's patent protections and a critic of increasing government's role in facilitating discounts for lower-income groups. It's uncertain where a free-enterprise approach to expanded discounts fits into that mix. But with the distraction of the two ballot initiatives now behind us, our public officials should now work effectively with health care groups and the drug industry to craft a program that truly helps Californians in need.


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