Pfizer doubling patient income limit for free drug program

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TRENTON, N.J. — Pfizer, the biggest U.S.-based drugmaker, is increasing its financial assistance to patients, doubling the allowable income level for people to receive dozens of Pfizer medicines for free.

The move comes amid fierce criticism by patients and politicians, as well as government investigations, of soaring prices for new medications and even old ones with little or no competition. A few companies have been accused of price gouging. Meanwhile, a continuing wave of mergers of both brand-name and generic drug manufacturers threatens to further limit competition, the primary control on prices in the U.S.

Pfizer Inc. Chief Executive Ian Read told The Associated Press in an exclusive interview that the New York company isn’t boosting assistance due to the heightened scrutiny of prices, but because more and more patients can’t afford needed medicines.

“We’re responding to challenges patients are having,” said Read, the immediate past board chairman of industry trade group Pharmaceutical Research and Manufacturers of America.

He cited insurance plans that shift more costs onto patients through higher medication copayments and deductibles that must be met before coverage kicks in, plus some Affordable Care Act exchange plans and insurance formularies that exclude pricier prescription drugs.

“There are people who are falling through the cracks through no fault of their own,” Read said. “As a stopgap, we’re willing to do this.”

Pfizer completed its $17 billion takeover of Lake Forest’s Hospira Inc. in September.

Pfizer will make an additional 44 medicines free for both uninsured and underinsured patients earning up to four times the federal poverty level, or $47,080 annually for a single person and $97,000 for a family of four.

The new limit is double the old one under the existing Pfizer RxPathways program. Between 2010 and 2014, it helped nearly 2.5 million people get more than 30 million Pfizer prescriptions worth more than $7 billion at list prices. On average, those patients received a monthly prescription for about a year, until they obtained better insurance coverage or other circumstances changed, said Caroline Roan, Pfizer’s vice president for corporate responsibility.

Last year, the RxPathways program helped about 350,000 patients. Pfizer expects to help a few hundred thousand more than that next year.

The increased income limit pertains to many popular Pfizer brands: pain relievers Celebrex and Lyrica, smoking cessation aids Chantix and Nicotrol, depression drug Effexor XR, the Prevnar 13 pneumococcal vaccine, Depo-Provera and other long-acting contraceptives, and erectile dysfunction pill Viagra. Nearly 20 other Pfizer medicines, including numerous expensive cancer drugs, already were free to patients making up to four times the poverty level.

New medicines for hepatitis C, cancer and many rare disorders carry list prices of $100,000 or more for a year or a course of treatment, though insurers often get big discounts. Meanwhile, insurance plans increasingly require patients to pay up to 30 percent of the price for the costliest drugs, rather than a fixed monthly amount.

Asked why Pfizer doesn’t just reduce list prices for its drugs in the U.S., where medicines generally cost a few times more than in other wealthy countries, Read said high prices are needed to fund innovative research on future drugs. That’s long been the industry’s mantra.

“Our prices, we think, are appropriate,” Read said. “We can’t lower the prices enough for (many patients) to afford it.”

Besides offering free medicines under the RxPathways program, Pfizer offers help working with insurance companies and connecting with foundations that assist patients, as well as discounts up to 50 percent off retail prices for its medicines, regardless of patient income. The company also provides cards that limit prescription copayments to a small amount, such as $25 per month, for patients with commercial insurance that can be billed for most of the drug’s price.

Such copay cards increasingly are being used by drugmakers to get around insurers’ formularies that put their priciest drugs on formulary tiers with very high copayments. Insurers and other critics say that increases overall health spending.

Pfizer has offered patients financial help for a quarter-century — as virtually all drugmakers do — and this year also donated more than $18 million to co-pay foundations for various diseases.

BY LINDA A. JOHNSON, AP Business Writer

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