Consider this a good news/bad news story.
West Virginians today can expect to survive well into their 70s,way beyond the rate at the turn of the century.
Innovative new medicines also have helped greatly. But the newmedicines have brought increased health care costs that manyinsurersand employers are struggling to control.Every five years since 1965, prescription medications have addedone year to life expectancy, said Alan Holmer, president ofPharmaceutical Research and Manufacturers of America, who spokebefore the U.S. Senate June 23.Between 1989 and 1998, 375 new medicines have been brought tomarket, the U.S. Food and Drug Administration reports. Those includesuch popular drugs as Lipitor, for high cholesterol; Claritin, aantihistamine for allergies; and countless drugs for heart disease,cancer, diabetes and other life-threatening diseases.Earlier this month, the Wall Street Journal applauded thepharmaceutical industry in an editorial.'U.S. drug companies are one of the wonders of our age, inventingtherapies for ailments that were fatal or crippling just years ago,'said a June 14 editorial.But the spiraling use of these new drugs tarnish the other side ofthe health care coin.Drug prices themselves rose only 3.2 percent last year, accordingto Gabrielle Williams, spokeswoman for the pharmaceuticalmanufacturers.But sales of prescriptions grew 15.7 percent in 1998.If helpful medicines are available, people are going to use them,especially if they are reminded through full-page magazine ads andcommercials on national TV.A Time Inc. study released June 17 reported that one in fourpeople said they discussed a prescription drug with a healthprofessional after seeing an ad in print or on television.Drug companies spent $1.3 billion last year on direct-to-consumeradvertising, the report said. That was a 24 percent increase over1997.Prescription expenses at the Public Employees Insurance Agencyshot up 21 percent last year, said Director Robert Ayers.'Unless the pharmacy program is controlled, half of PEIA's costswill be prescriptions in five years,' he said.Medicaid paid $155 million in the 1998 fiscal year forprescription drugs, according to the Bureau for Medical Services.This year's estimate is about $182 million - up 17 percent.Private employers also are dealing with soaring drug costs.Columbia Energy Group's pharmacy costs are growing about 20percent a year, said spokesman Kelly Merritt.Besides direct advertising, Merritt attributes the rise to thevolume of new drugs developed and the aging of employees andretirees.Charles Steinmetz, manager of employee relations at Union Carbide,said the prescription drug program is one of the fastest-risingportions of Carbide's health care costs today.Weirton Steel's drug expenses rose 15 percent last year, said MaxFijewski, director of employee benefits and medical services.'There are more new medicines on the market,' Fijewski said. 'Inmost cases, there are no substitutes and no generic medicinesavailable.'A less expensive generic drug can be marketed after the seven-yearpatent on the name brand has expired. But even the cost of genericsis rising, said David Mathieu, spokesman for the Health Plan of theUpper Ohio Valley, the state's first managed care company.'It's crazy,' Mathieu said. 'Generics still are a far sight frombrands, but have doubled in price.'So what's being done to address the escalating expense ofmedicines?Carelink Health Plans, Camcare's health maintenance organizationthat has lost about $40 million since its start in 1994, issponsoring health fairs, traveling to work sites, refining a casemanagement program and monitoring patients taking certain drugs,suchas Rezulin for diabetes.A pharmacy and therapeutic committee reviews new drugs.'We have a six-month hold period from the time it is marketed tobe actually considered to be a formulary drug,' said Dr. ElizabethSpangler, Carelink's medical director.As with the diet drug combination Fenphen, sometimes the problemswith a new drug aren't discovered until hundreds of thousands ofpeople use it, Spangler said.In Mathieu's health plan, a pharmacy benefit manager negotiatesdiscounts with drug companies. In-house pharmacists and a formularyalso help hold down costs.But health maintenance organizations have spoiled their members,he said.'They slap down $5 for a prescription. That doesn't put a dent inthe cost anymore,' Mathieu said. 'You're going to see more and morerequire a percent co-payment on prescriptions, rather than a flatfee. It will get the consumer more involved in buying cost-effectivemedicines.'Nationwide, many large health plans recently restricted coverageof some of the top-selling drugs.Aetna U.S. Healthcare won't cover Prozac for depression, Lipitorto lower cholesterol or Prilosec to treat ulcers.Instead, most members must buy those drugs themselves or pay forthem at a higher co-payment than the drugs Aetna favors.That could happen in West Virginia, some say.Meanwhile, U.S. drug companies are testing more than 1,000 newdrugs, 354 for cancer alone.Like other managed care companies, Carelink officials believe if apatient truly needs a drug, it should be available. And the propermedication sometimes can stave off more expensive surgery andpreventfurther costly and painful complications.'We're trying to focus on quality and not just on cost,' Spanglersaid.Writer Therese S. Cox can be reached at 348-4874.
