For-profit patient-assistance firms under fire: fees for free medicines?(Practice Trends)

A for-profit industry is springing up to help patients apply for free medications from pharmaceutical manufacturers' patient assistance programs, a development that has engendered controversy.

Proponents of the industry claim that they help patients cut through the thicket of paperwork required by the pharmaceutical companies and that they remove the burden of filling out these applications from already overworked physicians' offices.

Critics maintain that these patient-assistance companies should not be charging patients for medications that they can receive for free. Attorneys general in several states are investigating the legality of the practice. And a spokesman for the industry implied that some pharmaceutical manufacturers may choose to alter or curtail their programs rather than deal with these for-profit entities.

Pharmaceutical manufacturers have a long history of providing free medications to patients who cannot afford them, said Mark Grayson, deputy vice president of the Pharmaceutical Research and Manufacturers of America (PhRMA). He said that in 2002 the industry assisted 5.5 million people in the United States by delivering 14 million free prescriptions with a wholesale cost of $2.5 billion.

But the process of applying for these programs is laborious for patients and doctors, said Dr. Paul Kinsinger, a family physician in Washington, Ill., who has established the Helping Hands Prescription Service, a for-profit patient-assistance company. After a $15 application fee, Helping Hands charges patients $4 per prescription per month to process their applications for the pharmaceutical manufacturer programs.

"We're trying to be the H&R Block of prescription applications," Dr. Kinsinger told this newspaper. "You can file your own income tax much cheaper than you can have H&R Block do it, but H&R Block can do it much more efficiently and may find you some money that you didn't know about." He estimated that there are three nationwide companies offering this service as well as perhaps 300 small companies like his own.

Dr. Kinsinger's fees are apparently at the low end of the scale. Other companies charge up to $25 per prescription per month, and some charge a percentage of the drug's retail price, said Sandy Moulton, director of patient assistance and reimbursement programs for GlaxoSmithKline in Research Triangle Park, N.C.