Extended Interview: Tricia Neuman on Prescription Drug Discounts

SUSAN DENTZER:

Roughly how many of these cards are there out there, as far as we know?

TRICIA NEUMAN:

We actually don't know how many are out there. We think it may be dozens that are out there today, but I don't think there is a definitive count of the number of discount cards, and they seem to pop up every day, so it's actually hard to keep a count of how many there are.

SUSAN DENTZER:

What do they offer discounts on?

TRICIA NEUMAN:

They primarily offer discounts on prescription medication. Some offer discounts on other benefits like vision, and dental care. We saw one that offered discounts on aroma therapy. But basically, it is on prescription medication.

SUSAN DENTZER:

And is there any central clearinghouse of information about these cards, if I'm an individual and I just want to know what the whole range is?

TRICIA NEUMAN:

Well, boy, that's the hard part. There is no central source of information about prescription drug cards. So if you want information, and you want to know what kind of discounts you can get, you have to go to each discount drug card program individually, and you have to get information from that program individually, and that could mean going to the Web site, it could mean calling their 800 number. Sometimes it means going to a pharmacy to find out what the cost of your drug is with that card. But there's no place where you can go to get information on all the different discount drug card programs to compare prices to find out what you would pay with one card versus another.

SUSAN DENTZER:

What about how whether or not these sponsors of these cards are to tell you what your discounts are likely to be ahead of time, before you even sign up?

TRICIA NEUMAN:

Well, many of them do tell you discount information before you sign up, although not all do. I think one thing that we've found is that it's hard to generalize about these programs. There are as many exceptions as there are rules. But even if you can get information about the discount, we found that the discounts varied in terms of how they're presented, which makes it pretty challenging for consumers.

So, for example, some cards will tell you the price that you pay for a dose of your prescription, whatever it may be, but others, instead of giving you the price, will tell you it's a 12 percent discount off of the list price, or $12.37 discount, which you would then have to compare to what you would purchase – the purchasing price offered by another program. So sometimes the units that the discounts are presented in vary from card to card, and that can make it very confusing for a consumer.

SUSAN DENTZER:

In general, how easy or difficult do you think it is for consumers to find out all this information, figure out what is the best card to enroll in, and actually purchase their drugs that way?

TRICIA NEUMAN:

Well, I think it takes a lot of work for a consumer to figure out what they would pay and how they could save money with various discount drug card programs. There really is a burden on the consumer to be a good shopper, to go to the Internet, to go to the pharmacy sometimes, there's a lot of work that's involved in being a well prepared consumer. And while the savings may make the work quite worthwhile in the end, it is quite a bit of work, and if you think about the elderly population and the people who are out there looking for savings on their prescriptions, it is a – we are required – they are being required to do an awful lot of leg work in order to find out what savings they can get.

SUSAN DENTZER:

Are these card programs regulated?

TRICIA NEUMAN:

No, they are not considered health insurance or insurance products, so they are virtually unregulated today. There are a few states that have started to clamp down on discount drug card sponsors because they have had concerns about marketing problems. Arkansas is an example of such a state.

SUSAN DENTZER:

In terms of cards coming down stream in the future, we know that there is one in particular now being put together called Together Rx. Let's talk about that, let's talk about what you think is the future. Are these card programs going to proliferate in the future?

TRICIA NEUMAN:

We have seen a number of cards sponsored by the pharmaceutical manufacturers themselves come onto the market. Together Rx is the most recent card to emerge, and that is sponsored by seven different pharmaceutical companies. This may well be the wave of the future, at least in the foreseeable future, while the Medicare debate is being more broadly negotiated or discussed.

These programs can offer discounts on the drugs that are offered by the pharmaceutical companies that are sponsoring the card itself. So what that means for a senior is that if they happen to take prescriptions that are covered by that card and made by those pharmaceutical companies, they may be able to get savings from a particular card, but as long as they have prescriptions from a variety of different drug manufacturers, they may need a card from Together Rx, but they might need a Pfizer card, or a Merck card, or a card from another company.

SUSAN DENTZER:

What's in it for the big pharmaceutical manufacturers to offer these cards?

TRICIA NEUMAN:

Well, I think it is a genuine attempt to help low income seniors in particular who have trouble with their drug expenses, and I maybe perceive this as an interim strategy before a Medicare debate, before a Medicare benefit is fully kicked in.

SUSAN DENTZER:

Let's talk about the cards that some of the major drug manufacturers have introduced. Are those radically different from what's already out there?

TRICIA NEUMAN:

Well, they are different in a couple of ways. The private discount drug cards that are not offered by the pharmaceutical companies tend to be offered to people without regard to age or income. So it's for seniors, it's for young people, and they can be at any income group to benefit from them. Also, the private cards that are not sponsored by drug companies include drugs from a variety of different manufacturers. So by contrast, the cards that are being sponsored by the pharmaceutical industry tend to offer drugs – exclusively offer drugs that they themselves produce, and they also tend to be limited to seniors with low incomes.

SUSAN DENTZER:

And in the case of Together Rx –

TRICIA NEUMAN:

Together Rx is an example of a card that is limited to people with low incomes, but they do go up to, I think, three times the poverty level, so it's not – it also reaches people and helps people with moderate incomes.

SUSAN DENTZER:

What's in it for these manufacturers to offer these cards?

TRICIA NEUMAN:

These cards do – for the manufacturers, these cards are a way of helping low income and moderate income seniors with their drug expenses in an interim, in the interim, while – These cards are a way for the manufacturers to assist low and moderate income seniors as a Medicare debate or Medicare benefit expansion is being considered by Congress.

SUSAN DENTZER:

So it's a way of kind of –

TRICIA NEUMAN:

It's a short term – it's a – It's a way of helping. It's obviously not the same as a Medicare drug benefit, but it is a way to help low income seniors. It's an interim solution.

SUSAN DENTZER:

Now, into all of this has come the proposal from Medicare to endorse its own version of prescription drug cards. It may be one, it may be a number depending on who decides to play in this arena. What is it that Medicare is proposing to do?

TRICIA NEUMAN:

Medicare is proposing to allow private firms to offer discount drug cards that would be Medicare endorsed. So this means that a private company today that is offering a discount drug card could do the same, but this time it could say it would be a Medicare endorsed card, and they could market with the Medicare name.

The hope is that by marketing with the Medicare name, more people would be attracted to their product, and with more people they would be able to negotiate lower discounts to bring down costs even further for seniors.

SUSAN DENTZER:

What are your concerns about a Medicare endorsed discount card or setup cards?

TRICIA NEUMAN:

Well, I think the advantage of a card like this is that it could produce a lower cost for seniors. But a possible concern is that if a senior has a card that says Medicare on it, that they might have the hope that they actually have a Medicare drug benefit. When they have their Medicare card today, they know Medicare pays, say, 80 percent of their doctor bills. But with a Medicare discount drug card, they may get a discount, and that discount might be 10, 20, 30 percent even, but it's not the same as an insurance card that would pay 80 percent of their costs. And I think there is a real risk that seniors could be confused by the benefits of the card.

SUSAN DENTZER:

What about concerns from a larger standpoint, that it's somehow for people who want to see an expansion of Medicare to cover prescription drugs. Is this the kind of thing that might delay the process – the policy process moving forward as people say well, people have something now that's helping them out, there's no reason to rush into a Medicare expansion?

TRICIA NEUMAN:

Well, I think most people would agree that this is really not a substitute for a Medicare drug benefit, and even if this program is put into place in the near future, it may offer real help for seniors. It may produce savings of 15-20 percent, and it may save hundreds of dollars. But I think the demand for a Medicare drug benefit will still be very real, and that seniors will continue to press for real insurance like workers have today because they will still face high costs for their prescriptions, even with the discount card.