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Looking For A Less Expensive Asthma Medication

July 5, 1993

WASHINGTON (AP) _ It’s a long way from Emmett, Idaho, to Mexico, but that’s where Roberta Ashby gets her asthma medication. The South of the Border connection saves her $2,500 annually.

Mrs. Ashby, a retired saleswoman, stocked up on the Mexican drug when she and her husband, Turner, vacationed in neighboring Arizona a year ago. And this past winter, when they couldn’t make the trip, they had a daughter in southern California buy the medication for them.

″Even if you had to go down by bus, you’re going to save money,″ Ashby said.

Neither Medicare nor the Ashbys’ supplemental insurance policy covers out- patient prescription drugs. That doesn’t sit well with Ashby and ″you better believe″ he wants President Clinton to fix it.

As a presidential candidate, Clinton was appalled by stories of people forced to choose between buying medication or groceries. As president, he wants to make sure Americans don’t have to face that dilemma.

″It’s a major concern,″ said Robert O. Boorstin, spokesman for the White House Task Force on Health Care Reform.

Clinton’s health care reform package, now scheduled for release in the fall, is expected to include prescription drug coverage as part of the basic benefit package, with patients paying some of the cost. The plan also will include ″some kind of mechanism to control costs,″ Boorstin said.

Of the nation’s $900 billion health bill, about $62 billion is spent on prescription drugs. The Pharmaceutical Manufacturers Association estimates that 72 million Americans lack ″the kind of insurance they should have″ to pay for them.

A report last year by Families USA found that 63.7 percent of people 65 and older had to pay for their prescription drugs out-of-pocket, as did 53.5 percent of people under 65. The report was based on 1987 data.

It’s tough for people on fixed incomes. Consumer activists say some people are forced to stretch out prescriptions by not taking the required dosage or forgo the medication altogether.

In some cases, patients will opt for more expensive surgery or wait until the condition becomes acute because their prescription drug costs aren’t covered but their surgery and hospitalization is.

″It’s more expensive for the country not to cover pharmaceuticals,″ said Dr. Richard J. Boxer, a urologist in Milwaukee.

He cites the case of a prostate cancer patient who chose to have his testicles removed surgically rather than pay $400 a month for the rest of his life for a medication that would have made the operation unnecessary.

Joseph E. Smith, executive vice president of Warner-Lambert Co., said the average prescription costs $25-$26. He calls them ″such a bargain, such a value.″

But he acknowledges, ″Sure, it’s a lot of money, if you don’t have it.″

The industry supports the concept of a comprehensive drug benefit within a system of managed competition, but talk of any price controls is anathema to them.

Jeffrey Trewhitt, PMA spokesman, said the industry expects to spend $12.6 billion on research and development this year. Price controls would dry up investment capital and destroy the biotechnical industry, which is developing a lot of the new drugs to treat cancer, AIDS and other diseases, he said.

Pharmaceutical companies say they’ve had to boost costs because generics - cheaper duplicates of brand name medications whose patents have expired - now comprise one-third of the market.

And they say they’re being pushed into giving bulk discounts to health maintenance organizations, mail order firms, teaching hospitals and others.

Nevertheless, the industry has instituted voluntary price restraints to hold prices in line with general inflation.

″We are extraordinarily responsible citizens,″ Smith said.

Smith said major pharmaceutical companies also have indigent programs for people who can’t afford their medications. All a doctor has to do is call, he said.

Critics say the industry’s voluntary restraints don’t address the price of new drugs.

And Rep. Bill Brewster, a pharmacist by trade, said the bulk discounts mean higher prices for the general public, and for the Medicaid program, in which prescription drugs are purchased through the local pharmacy.

Pricing policies also mean that people, like the Ashbys, can get medication cheaper by leaving the country.

″It’s an unacceptable situation,″ Boorstin said.

He said tens of thousands of Americans travel to Mexico each year to buy their medications. If they went to Europe, they’d find prices up to four times cheaper than in the United States, he said.

The industry says prices vary from country to country because of such things as currency fluctuations, differences in regulations, dosages and packaging, and the high cost of product liability litigation in the United States. In Mexico, PMA said, prices on all retail goods are cheaper than in the United States.

Some people contend that the companies are spending too much on advertisements and promotions and that’s artificially boosting the price of drugs.

″The ad campaign is the single biggest place where the money is going,″ said Arnold Bennett, spokesman for Families USA.

″They spent $1 billion more last year on lobbying and advertising than they did on research,″ Boorstin said about the pharmaceutical companies.

″Should something be done? Yes.″

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