Before the state got involved,
an Aina Haina company
was already matching patients
with free drugs

By Lyn Danninger

For patients unable to afford the cost of prescription drugs, Gov. Linda Lingle's plan to provide medicine to the needy with the help of $3 million from the Weinberg Foundation came as welcome news.

But program is not the first of its kind in Hawaii.

A private-sector initiative launched by an Aina Haina internist, Dr. George Seberg, and one of his patients, retired businessman Chuck Malm, began quietly last July when the two formed the nonprofit Medicinal Economics and Distributive Services, at 850 W. Hind Drive. The two began helping patients gain access to drug companies' so-called patient assistance programs.

These same programs are the basis for Lingle's plan, Prescription Care Hawaii.

However, drug company programs have strict income guidelines that restrict help to people at or near the poverty level. Not all patients -- even if they are poor -- can qualify for the programs.

"It takes persistence and you do have to be down on your luck and really need it to qualify," Malm said.

To track the pharmaceutical company patient assistance programs, Malm said he spends much of his time using the Internet to monitor programs. He also calls the companies to stay abreast of frequent changes in requirements that are part and parcel of such programs.

"Each one is different. A lot of them are good for a year but they give you a three-month supply. However, the doctor or social worker or whoever is helping you has to call in before the three months is up. Some will say you can have refills indefinitely, but each one is different and you still have to do the paperwork," Malm said.

There are about 350 people now participating in various drug company programs with Malm and Seberg's help.

Most are on maintenance medications for such conditions as diabetes, high cholesterol or other illnesses that require ongoing prescriptions, Malm said.

Those patients without a regular physician who inquire about the program and may need medication can also consult with Seberg. But most times physicians will refer patients to the company for help accessing the programs.

"There are actually around 40 to 50 doctors who are sending us patients now," Seberg said.

When the company gets inquiries from patients who cannot afford their medication, Malm explains the programs, downloads appropriate forms from the pharmaceutical companies' Web sites, such as patient questionnaires, and goes over what needs to be done to qualify.

Patients fill out their portion of the application and then take it to their physicians to complete.

Malm said programs run by the drug companies can get quite complex and confusing, especially for a patient on multiple medications from different companies.

"I was helping one patient who was on six different drugs from five different pharmaceutical companies," he said.

In addition, some of the programs require that patients prove they qualify for the programs by providing income information, such as their last tax return.

If patients cannot qualify for the corporate assistance programs, the next step is to help them purchase drugs at lower cost through Canadian pharmacies' mail-order drug programs.

Malm and Seberg set up another company, Canada Discount HealthCare Services of Hawaii, for that purpose.

Originally from North Dakota, Malm said he was familiar with seniors living in U.S. states bordering Canada who regularly head north to fill prescriptions at a lower cost. His mother was one.

Today, Malm works with 29 pharmacies throughout Canada, he said.

Even though the company makes no money on the drug company patient assistance programs, it does make some money on referrals it sends to the Canadian pharmacies' mail-order program. That income helps to defray some expenses, Seberg said.

"We're certainly not getting rich but it's enough to cover some administrative costs," Seberg said.

Malm and Sebert are hopeful it will eventually help to offset all the costs of the work they do. Their biggest expenses are advertising costs related to getting the word out about their programs.

"We've spent about $17,000 since last July but have so far taken in about $1,100," Malm said.

The company also maintains its own Web site at where it answers questions commonly asked by those interested in the program.

Once the initial paperwork is done, such as the completion of a health questionnaire and authorization form, the U.S. prescription is sent to Canada where it is reviewed and co-signed by a Canadian physician before it is filled. It usually takes several weeks to receive the drugs from the date of order, which is why the program works best for those on regular maintenance drugs, Malm said.

Cost savings for many common drugs can be significant.

For example, the lowest cost at a Hawaii pharmacy for popular cholesterol drug Lipitor would be about $285 for 90 20-milligram tablets. Through the program, the same drug with the same dosage would cost around $166, Malm said.

Similarly, 100 10-milligram tablets of Tamoxifen, a drug commonly used in the treatment of breast cancer, cost around $26 using the program. The lowest cost at a Hawaii pharmacy Malm could find for the same dosage and same number of tablets was just over $155.

The growing number of seniors nationwide who now either go to Canada to fill their prescriptions or purchase medications from there via mail order has not gone unnoticed by pharmaceutical companies. One, Britain-based GlaxoSmithKline Plc, tried to put a stop to the practice by saying it would no longer sell to Canadian Web-based pharmacy groups who were actively selling to U.S. patients.

One Canadian pharmacy group responded by sending out 220,000 letters to its U.S. customers asking them to boycott Glaxo's over-the-counter products.

Still, Glaxo responded to the boycott in a statement, saying seniors could be "putting themselves at risk from unsafe or counterfeit medicines that may come from poorly regulated, unlawful, cross-border, Internet sale of medicines."

Such statements from a drug company don't make sense, said Dr. Robert Sussman, a Canadian whose family practice, the Medical Corner, is in Kailua.

"The Canadian pharmacies are at least as regulated as those in the U.S," he said.

The services Malm and Seberg provide are needed, Sussman said.

Most doctors do not have time to keep up with all the different patient assistance programs, much less complete all the paperwork, he said.

"I don't think there are a lot of doctors doing it and it really depends on the type of practice they have. Certainly those who are very busy couldn't do it," he said. "I also think it takes a special kind of doctor who'll take the time."

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