HD31 - Pharmaceutical Assistance Programs and Discount Purchasing Cards

Executive Summary:
House Bill 1202 of the 2004 session of the Virginia General Assembly asked the Commissioners of the Virginia Department of Health (VDH) and the Virginia Department for the Aging (VDA) to explore the feasibility of developing a unitary application form that would be accepted by all current non-Medicare-approved pharmaceutical discount cards. Following discussions with relevant entities, the Commissioners of Health and of Aging are of the opinion that the life expectancy of flat-fee pharmaceutical manufacturer-specific cards is very limited. Considering all known factors, it is the conclusion of VDH and VDA that the remaining free-standing cards will cease to exist upon the initiation of Medicare Part D in 2006.

Actually trying to cover all data that may be required to obtain eligibility for any and all pharmaceutical assistance program or pharmaceutical discount purchasing cards effectively negates the likelihood that Virginia could design a single, concise application form that is logically formatted and written in clear and easily comprehensible language. Further attempts to integrate all of these formats are likely to encounter resistance by the pharmaceutical industry. An application designed to accomplish the former would be too complex and too cumbersome in order to accomplish the latter.

VDH and VDA further observe that the design of the current transitional Medicare drug benefit for low income seniors has provided an incentive to switch to Medicare-approved prescription drug cards for many who formerly might have pursued free-standing discount cards. For individuals having incomes no greater than 135 percent of federal poverty to obtain the full $600 "free drug" transitional benefit offered in 2004 and 2005, one must have a Medicare approved discount card, and must have no other prescription drug assistance.

However, VDA and VDH believe that programs offering low cost and no cost prescription assistance to persons having incomes near poverty levels, whether from individual pharmaceutical companies such as Merck, or through the auspices of the Pharmaceutical Research and Manufacturers Association (PhRMA), will continue regardless of changes in the Medicare drug benefit. Not limited to those over 65, these programs require the participation of pharmacies and/or physicians, have widely diverse applications and eligibility requirements, and are considered extremely difficult for average consumers to navigate.

A software system entitled Pharmacy Connection, owned and distributed by the Virginia Health Care Foundation, a public-private partnership established with the assistance and participation of the Virginia General Assembly, permits an applicant to apply for low-cost and no-cost prescription assistance from all available programs simultaneously. While use of Pharmacy Connection is labor-intensive, the resulting value of pharmaceuticals delivered to Virginians has been truly impressive. Based upon the potential of savings and volume of drugs that can be accessed efficiently, VDH and VDA recommend strongly that additional Pharmacy Connection access sites be established throughout Virginia.