Banning Prescription Assistance

Picture this. You receive a prescription from your doctor. Then you find out from your pharmacist that your co-pay is over $300 for only 30 tablets.

This is what thousands of Americans have to go through. And there is help available- but not if you live Massachusetts.

Michael Rafferty,62, is a former liver transplant patient and advocate for the prescription coupon programs.

“There was a time when I found myself spending about two thousands dollars in co-pays for my medications,” Rafferty said. Medications that he needed to buy on a monthly basis just to live.

Rafferty was on a donor list for months before finding a match. And he considered himself very lucky that it only took months.

But then he needed medication that would allow his body to get used to his new liver.

“I thought that I had pretty good insurance, but the more medications I had to be on, the more expensive,” he said.

Rafferty had Aetna as his prescription plan at the time. When asked why the co-pays were so high, a representative from Aetna answered that it was due to the pricing set by the manufacturers of the medication.

"The better the deal, the lower the co-pay," he said.

Rafferty was then told that there were companies that would help cover his costs. Companies like Pfizer, Eli Lilly, and Bayer.

“I called the number and they asked for my name... and date of birth... but as soon as i said that I lived in Massachusetts... They said ‘Oh, I’m sorry Mr. Rafferty we can’t help you because Massachusetts doesn’t allow assistance’,” he said.

Since 1972, Massachusetts has been abiding the federal anti-kickback law. This prevents bribes and other forms of payments from drug companies towards health-care providers.

That way doctors would not feel tempted to prescribe patients a particular medication just because they may receive a free cruise from it.

However, due to the unclear language, the law was interpreted by Massachusetts legislatures to include prescription coupons, along with patient assistant programs since it offered a massive discount on the medications.

Jen Daly works with Mass Rx Help. It is an organization that is making it a mission to get rid of what is now known as “the prescription coupon ban.”

“What I don’t understand is why it’s taking Massachusetts so long,” Daly says. “It's the only state in the whole country....you would think that there would be someone who would see something wrong with that.”

State Representative Charley Murphy says that it's not as easy as it seems.

"It's a process," he said. "The bill was passed last summer through the house, but then the senate saw something that they didn't like-and just sent it back. The bill isn't just about banning the prescription coupons or assistance programs," he said.

Murphy explained that the bill would also affect the medicare plans that are offered to seniors.

"If more people use the patient assistance program, that may drive-up the premium costs here in the commonwealth," he said. "And we have one of the best programs for seniors around."

But in the meantime, Mass RX continues to get encountered by liver transplant patients, cancer patients, and those with Multiple Sclerosis (MS). Mostly because of the average retail cost for a medication.

According to Bayer, they sell their one month supply of Betaseron for $2,998. This medication is an inter-feron and helps MS patients by protecting the myelin sheath. By protecting the myelin sheath, this prevents spasms, fatigue, and even paralysis- or at least slows down the process towards paralysis.

And if a patient does not have Mass Health-which does pay for these medications, private insurances can still charge a co-pay of $75 like CVS Caremark, or $1500 like Harvard Pilgrim, for just a one month supply.

“There was a young college student who was diagnosed with Multiple Sclerosis that I was trying to help,” Daly said. “This semester, she transferred to a college in Philadelphia just so she can enroll in the Patient Assistance program.”

If an MS patient enrolls in a patient assistance program through manufacturers like Bayer, the most they will pay is $25 for a 3 month supply according to the plan.

According to CVS Carmark,the reason why the price is lower than their co-pay is because the drug is sent directly from the manufacturer.

"It's no different than the idea of a wholesale or outlet store," Elicia Fauvel, pharmacist of Caremark said.

"So they are able to modify the prices. Once it's sent to a retail venue, the company still wants to get paid for the distribution," she said.

And since there are so many types of insurances, there are only a handful that are able to get a special deal on the wholesale price of the medication. This price will then determine the tier of the medication, and therefore the co-pay.

But Daly is still very frustrated that the senate sent the bill back to the house.

“We are now in the winter months, and nothing is happening at the senate level,” Daly said.

Representative Murphy says that the Senate has until 2013 to pass the bill. So Daly and her team are going to have to wait a bit longer.

Rafferty is now receiving benefits for being a Veteran through the VA Medical Center in Jamaica Plain, and now is co-pays are only around $10 for a one month supply he says.

But he is still speaking to politicians in the Boston area in hopes of lifting the ban and expediting the process.

“I still feel like this is my issue, and I am still going to keep spreading the word until something is done,” he said.

The Most Over-Prescribed Medications in Boston

Massachusetts is getting more strict about control medications. So I decided to ask pharmacists in the Boston area what they felt was the most over-prescribed medication. I present to you, the top four!

The Most Over-Prescribed Medications in Boston from Tamara Starr on Vimeo.

Stimulants: The Academic Choice

It was first assumed that kids were in danger of going to their parents liquor cabinet. Now it seems that the medicine cabinet is the new hot spot.

What was first known as a drug for young children with ADD or ADHD, has now turned to a students solution for getting A’s.

“This is a population that is really good at keeping it under-wraps,” says Johanna Hammer, Clinical Therapist and Social Worker.

“For these students, this is the jackpot drug,” she said. Hammer explains that the reason these students love medications like Adderall is because it’s a stimulant.

“It’s not like an anti-depressant which has a much lower rate of success,” she said. “With amphetamines you are able to feel the effects immediately.”

Stimulants such as Adderall, Ritalin, and Concerta affect the central nervous system. When a person has ADD or ADHD they are not able to keep focus, and can very distracted in mid-conversation.

These drugs are able to send neurotransmitters to the brain and create an "alert" or "wired" feeling and then can cause the person to feel very focused on a task.

Sarah Hall, 24, is a pharmacy student at the Massachusetts College of Pharmacy and Health Sciences (MCPHS). She has been struggling with a severe case of ADHD since she was a junior in high school.

"I remember looking at the teacher in the beginning of the class, and then all of a sudden class was over," she said. "I had no idea what went on... I would just look outside, or just look at the text in my textbook."

Sarah had no idea that it was ADHD, and it wasn't until she went from getting A's to getting C's, that her parents took notice.

"They were very surprised," she said. "But once it was figured out that I had it-and I was medicated... I started to perform well... academically again."

But now her biggest challenge are her friends.

“It seems that as soon as they find out that you have Adderall, you get harassed for it,” she said. “I can’t even tell anyone that I have ADHD because then you get friends of friends offering you money for them [medication]."

It is now very common for any student to get there hands on Adderall. And according to Boston University senior, Nina Sugawara, she has seen students offer as much as $50 for each pill.

“People can get addicted to this,” Hall said. “I’ve had my medication stolen from me in the library. They didn’t take my wallet, or my phone...just the drugs.”

When the Administration of MCPHS was asked how the issue of students stealing/abusing drugs was being addressed, they only issued this statement from Michael Ratty, Director of Communications:

Per federal guidelines, the impact of abuse of a diverse array of drugs (including stimulants) is addressed in the drug policy section of the student handbook. Also, Counseling Services and the Dean of Students office keep regular supplies of brochures about prescription drugs and abuse of prescription drugs in our waiting rooms. In addition, Resident Assistants are trained to discuss the issue with students. Last year, the College also produced a poster campaign about various types of drug abuse.

“If you feel that you need to take something in order to to do anything...That can be a sign of addiction,” Hammer said.

Doctor Chavin at Tufts Medical in Boston says that there are a lot more students who try to convince him that they have ADD.

The symptoms unfortunately are not too hard to fake. The symptoms include being unfocused, distracted, and fatigued.

“I’m not just going to give a prescription to someone who says they can’t focus,” he said. “I always suggest to try turning off the TV first.”

Hammer says that this particular drug is hard to fight.

“These students are not taking this to get high,” Hammer says. “They are taking these drugs to excel.”

This could be the reason why it is so hard to address. Because how can you fight something that is actually bringing good.

“I use to get girls who were cutting themselves,” Hammer said. “I now get scholars and students. These people don’t have pot dealers. They are getting legal prescriptions for it.”

Prescription for Addiction

In Brookline, he is known as “The Doc” amongst his friends. It could be because he is knowledgeable about prescription drugs. Or the fact that he has been on over 40 prescriptions in the last four years. And he is only 20 years old.

Out of fear of getting arrested again by Brookline police, he prefers to be called A.J. for the sake of the article. But he is trying to right his wrongs by seeking employment and weening off the drugs.

A.J.’s journey started when he was a sophomore in high school and he started feeling strange pains around his body.

The doctors first prescribed Motrin, then increased to Percocet, which then increased to Oxycontin and then Vyvanse- both very strong narcotics for pain. Narcotics are usually prescribed for someone who just got out of surgery.

“The pain was so strong, I felt that I needed something to help... And these helped...,” he said. “I just didn’t know how far it was going to take me.

A.J. turned into an addict. He took advantage of his medical care just to get more prescriptions. But then he started to involve his friends.

"It’s amazing how much money a person can make by selling pharmaceutics,” he said.

A.J. was given several prescriptions which included Viagra, Vyvanse, Cialis, and Opana. All of which he took, but would later sell to his friends for a profit. This behavior would lead him to almost drown in troubled waters.

Just last fall, A.J. was arrested while driving through New Hampshire for drug possession. They were all pharmaceutical drugs. But not all were from him. A.J. refused to answer how he got the others.

He explained how strange it was that young people were turning to prescription drugs. And he talked about how he wanted to create a program to warn parents of the risks.

However, the Brookline High School staff, felt that A.J. needed to get his act together first, before talking to students.

Hope Schroy is the substance Abuse counselor at the school. She has tried helping him in the past and says that there is no need for such a program.

"It's a good idea, I just can't allow (AJ) to come into the school and speak with students or even their parents."

According to a survey taken by the Monitoring the Future study last year, more young people were taking prescription drugs. Whether these medications are necessary has to be considered on a case by case basis.

Unfortunately, A.J. is struggling with his addiction. And when asked why he kept doing this, he just shrugged. His eyes remained glued to the floor and he couldn't say one word to answer the question.

So when asked which drug was his favorite, he re-focused, there was eye contact, and he felt comfortable again.

“Lyrica has the best high! I feel amazing after taking my dose. The only problem is that now I can’t survive the day without it,” he said.

Lyrica was originally prescribed to him for his fibromyalgia. His doctors are now trying to get him off of it because they feel that diagnosis may no longer be accurate.

But A.J. doesn’t believe that taking his medication orally is the best way. So when asked what is the best way, he just reached into his pocket and pulled out his snorting spoon.

“This is the best way...,” he says while holding it up.

When holding it up he seemed almost proud but also shameful at the same time.

“But I am trying to decrease my doses... It’s just going to take some time...,” he said.

But for now, he feels that inhaling allows the effects to be felt even faster.

A.J.’s mom is very supportive of her son. And she is very happy that he wants to spread awareness. But the problem is that he is still suffering from his addiction.

When she tried to respond to his arrests and his addiction to pharmaceutics, she started to cry.

“You didn’t know him.... You don’t know how he was before...,” she said. “My son was class president... he was in AP classes... He was planning on going to college...,” she says as tears roll down her face.

She then looks down at her feet. “But he is my son, and the doctors say that he is getting better... I sure hope so.”

Note: As of last week A.J. is now only taking two medications. His physicians are becoming more serious with him and A.J. hopes that won't have to depend on drugs like Lyrica.

Phantom Planet - Big Brat

I will forever miss them.....

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