Horror stories about retirees' outrageous bills for the drugs they must have to stay alive

By CHRISTIE VILSACK
October 17, 2004
DES MOINES, IOWA

I just returned from a 1,518-mile “Message in a Bottle” tour around Iowa, visiting 16 pharmacies and talking with Iowa seniors about the high cost of prescription drugs. The stories I heard made me feel ashamed that the richest, strongest nation on earth doesn’t have the will to take care of its frail and elderly. We call them the “greatest generation,” but we don’t treat them that way.

I took this trip on behalf of the Kerry presidential campaign, but it was the seniors and the pharmacists who delivered the message loud and clear. By week’s end I felt like I’d been through an intensive class that could have been called “Mediscare 101.”

First, I thought the seniors who joined me at the pharmacies would bring several empty prescription drug containers to drop in a basket I had brought along to collect them. I intend to deliver the empty containers to Washington, D.C., to deliver a symbolic message about the financial and emotional costs of soaring prescription drug prices.

When I finished my tour in Cedar Rapids, I had garbage bags full of containers and a few monthly bills thrown in for good measure. The seniors took the 7-day pill dispenser I handed out, but they said it wouldn’t begin to hold all the pills they need to take each day.

Seniors are angry. Pharmacists are frustrated, and we middle-agers better hope the next president and congress take care of the mess, because old age is no picnic when you have to eat cat food in order to afford the prescriptions that keep you alive.

Iowa seniors learned three weeks ago that their Medicare premiums went up 17 percent. This is too much for people living on fixed incomes. This money comes directly from their Social Security checks. That means they have to do without something – usually a necessity like food, heat or air conditioning.

Pharmacists at every stop nodded knowingly when I talked about the stories I’ve heard, and they added stories of their own. Seniors they know and serve are going without food or eating pet food so they can afford their medicines. They confirmed that their patients often cut their meds in half, take them every other day and share them with their spouses and other family members.

The Iowa pharmacists I met last week are trying to keep their family businesses alive and maintain the nurturing relationships they have with patients who’ve been relying on them for generations.

In Sioux City, the Drilling family – mom, sons and their spouses – work hard to meet the needs of the people in their neighborhood. They counsel seniors about the drugs they’re taking and check with doctors to be sure that the combinations won’t produce a bad effect. Pharmacist Bob Drilling explained to the crowd gathered that he isn’t allowed to set the price of the drugs he sells, and he isn’t allowed to know how much the Pharmacy Benefit Managers (PBMs), who do set the price, are taking from his pocket and the pockets of his customers.

At my first stop at A Avenue Pharmacy in Cedar Rapids, Gary Albers tried to explain to me and his customers how PBMs work. I thought PBMs were the airplanes my dad flew in WWII, but now I find that they’re more ominous. PBMs are part of a bureaucracy that pharmacists negotiate every day. PBMs are middle managers that handle the paperwork of dispensing medicine. They can take a little of the pharmacists’ profits, take a little from the insurance companies and sometimes they even own warehouses that distribute drugs. Law forbids inspecting their records to determine if discounts are being passed to seniors.

In Anamosa, Republican pharmacist Carl Chalstrom, tells the assembled group that the new Medicare Discount Card is worthless except for really-low-income seniors. He only has 10 people using the card. His sentiment is echoed across the state. A Dubuque pharmacist told me that she has to help the seniors in her care try to decide which of 70 plus discount cards to use to find savings.

In Maquoketa, Bob Osterhaus, a recently retired pharmacist and state representative, talked to friends and neighbors while his son Matt filled prescriptions in the back. Bob has worked with other Iowa pharmacists and the governor to craft a plan they hoped would be acceptable to Tommy Thompson, secretary of the Department of Health and Human Services in Washington D.C. The plan would allow the state of Iowa to certify pharmaceutical companies in Canada, to assure the safety of drugs, and then allow those companies to sell directly to Iowa pharmacies, which would pass the Canadian costs on to Iowans. The director of the Food and Drug Administration told the governor that this plan is illegal.

Waukee pharmacist Russ Wiesley is running for office, in part to work on healthcare issues at the state level.

In Ottumwa, a man in the audience outside Family Pharmacy wondered about the difference between the prices veterans pay for medicines and the rest of us. He takes Lipitor, and as a vet he pays 50 cents a day, while his wife takes the same drug and it costs $5 a day. If the Veterans Administration can negotiate for lower cost drugs, why can’t Medicare negotiate, the man wanted to know. I had to tell him the new Medicare law bans the secretary of the Department of Health and Human Services from negotiating lower prices.

I used an example of one drug called Prevacid. The cost in Iowa for a month’s prescription of this drug is $141.26. The cost of the same drug for a veteran is $70.85
The cost in Canada for the same drug is $44.27.

At every stop I heard stories of people driving to Canada for drugs or buying them illegally through the mail, sent in plain brown boxes.

In Council Bluffs, Tony Beraldi and his dad Tom assisted customers and tried to explain their frustration over patent extensions. Tony talked about a pharmaceutical company that extended the patent on their drug by adding Motrin to it. By doing so, they can continue charging the high prices that patents allow. Tony gets around it by suggesting a generic and a Motrin tablet to his patients, because it’s cheaper. He said he’d spent a good part of his day on the phone negotiating with PBMs over medications for customers. One of Tony’s customers presented me with pharmaceutical bill for the year – a startling $19,997.04!

The healthcare crisis is not just a senior issue. In Mason City a middle-aged man threw two containers into the growing pile and said, “That’s $4,000 worth of medicine.” In Cedar Rapids, a 32-year-old woman, Melissa, says she takes $400 of medicines a month. She has no insurance, so her mother helps but she just does without some of the drugs she needs for quality of life.

Some seniors currently have good health insurance policies that cover prescription drugs, but they’re afraid their benefits will disappear when insurance companies negotiate with their former bosses in order to lower the cost for their current employees.

A caregiver in Council Bluffs pointed out that going without nutritious food and taking drugs every other day creates other health problems that we all pay for.

Nobody I talked to during my 16-pharmacy tour is happy with the system. The pharmacists are pinched. The seniors are pinched. They know that someone’s getting rich and it’s coming from their pockets. Seniors want to do business with their Main Street pharmacists. They know it would be healthier and safer, but they know that there are affordable drugs across the border, and they don’t understand why it’s illegal for them to go where the price is right. I agree with them.

By the way, a senior in Cedar Rapids thinks it’s ironic that the president is going to import flu vaccinations from Canada. Go figure.