Drugs, free

PENITAS - A combination of at least eight prescription medications a day make Janie Garza the happy, generous and active person she is - despite her diabetes and heart problems.

The monthly cost of her good health: more than $1,300.

At 55, Garza is too young for Medicare. With her husband working full-time and her on the clock part-time, the Peñitas couple makes just a little too much money to qualify for Medicaid. Neither of their jobs provides private health insurance.

Fortunately, for the last five months she has gotten most of her drugs for free - through seven different pharmaceutical company "patient assistance" programs.

The forms to fill out are confusing and the process of finding the programs takes time, but more low-income patients are discovering ways to get the most expensive prescription drugs - those that do not yet have cheaper generic forms - for free or on the cheap.

"Many doctors don't know they can help their patients through these programs," said Dr. Enrique Griego, a family practice physician who works in McAllen and Rio Grande City.

Complexity

Although many of these company or industry-funded programs - with names like "Lilly Cares" and "Pfizer Pfriends" - don't serve those who qualify for Medicare or Medicaid, the uninsured and the poorly insured can save serious money.

In combination with low-cost generics available from Wal-Mart and H.E.B., such programs can provide for people who would otherwise go without, says Shirley Arnolde, administrator of Clinica Maria Luisa in Peñitas.

Web sites like pparx.org or needymeds.com can match medications, ages and income levels with different programs, but the number of options and variables can be dizzying.

Free pharmaceutical programs are often listed alongside less effective drug discount cards on such sites.

"It gets so confusing, so ... a lot of people get sucked into saying ‘Oh, I can get a discount on my medications,' whereas they were eligible to get it for free through their drug company," she said.

"It's a big game," she added. "You could make a full-time job out of this."

Some companies and individuals have, charging patients a fee for searching out appropriate programs and filing applications on their behalf.

Many programs require proof of income in the form of tax forms or pay stubs, as well as proof of residency. Very few programs help illegal immigrants.

Some local doctors charge patients a $10 or $20 fee for their staff to fill out the forms, said MariaElena Cavazos, a manager at the Valley Association for Independent Living. Other doctors, clinics and programs will perform the same service for free.

Cavazos estimates she filled out forms at VAIL for more than 50 patients in the last year, some of whom needed as many as 15 different medications.

The non-profit, which operates offices in McAllen and Harlingen, specializes in the disabled but does not turn away anyone who needs help with the tricky paperwork, she said.

"You can't fill them out in blue; it's got to be black ink. If one question is not answered, they'll send it back. (Companies) are very, very picky," she said. "A lot of doctors just don't have the time to do this."

Medicare and prevention

One problem that's arisen was intended to help low-income patients: Medicare part D.

The prescription benefit, added to Medicare in 2006, is available to those who qualify for Medicare coverage, but co-payments can be hundreds or even thousands of dollars for the most expensive medications.

Eligibility for part D now disqualifies many from prescription assistance programs, Arnolde said.

Because many applications for programs ask about eligibility for state assistance and about the availability of private insurance options, a few Medicare recipients have ended up losing their free medications.

"That has hurt a lot of people," Arnolde said.

Griego said he keeps forms for many programs on hand in his office because otherwise, many of his sicker patients will give up and their condition worsens.

"You need to ask and not just be at home, saying you don't ask for medicine because you don't have money, until you have complications," Griego said. "I think that the best way that we have to distribute money is in prevention."

For Garza, of Peñitas, the drugs her doctor prescribed weren't available in generics or weren't on the lists of popular drugs that Wal-Mart and H.E.B. now dispense for $4 or $5 a month. She tried switching to cheaper insulin, "but it wouldn't do the job."

Pride and hopelessness kept her at home, sharing insulin with her husband and going without medication for her heart and blood pressure.

"I felt like I was underground," she says. "I was very emotional and depressed ... Now, I want to continue, and I love life."

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Sara Perkins covers Mission, western Hidalgo County, Starr County and general assignments for The Monitor. You can reach her at (956) 683-4472.