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Heavy Burden on West Virginia: ; Pharmaceutical Advocate Should Not Delay Mission

Posted on: Wednesday, 10 August 2005, 00:00 CDT

BOWING to demands of drug makers, Congress voted in 2003 to deny the federal Medicare program power to negotiate lower drug prices. But West Virginia's Legislature and governor gave Pharmaceutical Advocate Scott Brown this very power when they enacted and signed House Bill 4084 last year.

Some West Virginians have recently criticized Brown for moving too slowly to use his powers to negotiate lower drug prices for West Virginians.

Specifically, critics assert that Brown has lagged in two jobs to prepare the foundation for negotiating with drug makers. One is to create a common formulary - a list of approved drugs - for public employees, Medicaid and other programs. The second job is to consolidate administrative functions of various state agencies that now finance prescription drugs.

If the critics are right, the people of West Virginia will pay for these delays - in higher drug prices when they fill prescriptions, and in avoidable suffering if they can't afford their medications. Please consider the evidence:

West Virginians are second-highest in the nation in the share of their incomes that they pay to drug makers. West Virginians spent 3 percent of income on prescription drugs in 2002, just behind Tennessee and three-fifths above the national level.

Drug spending in West Virginia was almost one-quarter above the U.S. per-person average, owing mainly to higher use of medications. Higher use isn't surprising, since the state ranks near the top in elderly population, in the percentage of people with diabetes, and in the death rate from heart disease.

While the legitimate need for medications is high in West Virginia, average incomes are low, barely three-quarters of the national average.

The combination of high spending on medications with lower incomes means that drug costs are a heavy burden, consuming almost 60 percent more of West Virginians' incomes than the national average.

The only decent way to make medications affordable in West Virginia is to lower their price. That is Pharmaceutical Advocate Scott Brown's mission, according to the Legislature and the governor.

If he fails, what will happen? More West Virginians will suffer avoidable pain, disability and avoidable premature death for lack of needed medications.

A look at neighboring Tennessee shows how this might play out. Tennessee recently decided to cut its TennCare (Medicaid) program, throwing almost 200,000 people off the rolls and limiting most remaining patients to five prescription drugs monthly, two brand- name drugs and three generics. For patients with multiple chronic illnesses and disabilities, that's often not enough.

Tennessee's governor and legislature were not willing to take on the drug makers, so they took on lower-income people with disabilities and chronic illness instead. They would not fight to cut prices, so they decided they had to cut the number of people they'd help and how much help they'd give. (Some Americans might think this was not particularly brave or moral.)

It is wrong for politicians to rip away health insurance coverage or set arbitrary limits on use of needed medications. These limits make no sense - not politically, not financially, and not medically.

* Politically, why would politicians embrace drug makers and not citizens? Do campaign contributions really matter more than votes?

* Financially, once valuable medications are developed and factories are built to produce them, the actual cost of making, distributing and dispensing a monthly supply of a prescription drug is usually only a few dollars. With the actual cost so low, it is a tragedy to deny meds to patients who need them. Further, when drug prices are cut, more patients will be able to fill prescriptions, making it possible to replace the revenues that the drug makers lose from the price cut itself. At the same time, patients who use the medications they need can avoid some costly and unnecessary hospitalizations. Patients, payers and drug makers can all win.

* Medically, doctors should use evidence to write prescriptions for every patient who needs them. Politicians should not be allowed to rip up those prescriptions.

There are two more big reasons to act to lower drug prices.

First, Americans will spend over $250 billion on prescription drugs this year, one-half the world's total. (Yet we're only 5 percent of the world's people.) It's therefore reasonable to conclude that we are already spending enough to get all the meds that work into the bodies of all Americans who need them. The reform formula should be lower drug prices plus higher volumes of use of needed meds. Together, these can combine to cover everyone without visibly increasing spending or hurting drug makers and their research.

Second, new evidence indicates that total health care spending in West Virginia this year will exceed one-quarter of the state's economy, the highest share in the nation. Much of this money comes through Medicare and Medicaid payments from Washington, but some of these payments are threatened by the nation's trade deficit and federal budget deficit.

Despite the high spending, the share of West Virginians lacking health insurance will actually be a little above the national share of 16 percent.

If West Virginia doesn't get its health costs under better control, how will it be able to cover more people - or attract more good jobs that provide health insurance? Negotiating lower drug prices can help.

That's the job of Pharmaceutical Advocate Brown. We should all hope, pray and demand that he pursues his duty with vigor and without delay.

Dr. Sager counseled the Legislature during passage of West Virginia's prescription cost plan. He and Socolar, MPH, are directors of the Health Reform Program at Boston University School of Public Health. Their agency's analysis of prescription drug problems is online at www.healthreform program.org.

Source: Charleston Gazette, The

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