Tennessee ranks first in statewide prescription cost burden

By Jennifer Lassiter
Star Staff
jlassiter@starhq.com

   When the pills run low, Georgia Shoun doesn't hesitate to fork out another $200 a month for her prescription drugs. Being uninsured can be expensive, but according to Shoun she'll do without other things before giving up her much needed medication.
   Shoun, 75, from Elizabethon, is currently taking four prescriptions, soon to be five, for her diabetes and arthritis. "Something needs to be done," she said. Shoun is uninsured, and pays for her proscriptions out-of-pocket.
   A report by the Health Reform Program at Boston University School of public health ranked Tennessee first in prescription drug costs.
   Nationwide, prescription drug spending rose from 1.2 percent of personal income in 1998 to 1.8 percent in 2002, an increase of one-half in just four years.
   According to the new study, prescription drug costs consume a rapidly rising share of Americans' incomes, and that share varies enormously among states. The burden is generally heaviest in poorer, sicker, older states where more people are uninsured.
   Dr. Tyler D. Hyder, pharmacist at Burgie Drug in Elizabethton, said, "In rural areas there are fewer jobs, not a lot of industrialization, so we don't spend as much on education; We have a lower workforce and less insured people; It's a vicious cycle."
   Tennessee's top-ranked prescription drug cost burden was 3.1 percent of income in 2002, nearly double its 1998 level. Tennessee's burden was more than twice the 1.3 percent of income spent on medications in California that year.
   The study ranks states with the greatest drug cost burden in 2002 as Tennessee, West Virginia, Kentucky, Louisiana and Mississippi.
   "States that suffer especially heavy drug cost burden and those where the burden is rising fastest are likely to feel the most pressure to act politically to lower drug prices," conclude authors Alan Sager and Deborah Socolar, directors of the Health Reform Program.
   What is Tennessee's solution?
   Governor Bredesen's Tenn Care proposal that was passed this session, states controlling growth in pharmaceutical costs must be central to any reform. The strategy limits the number of prescriptions to no more than six per month (except for children and pregnant mothers and disabled).
   Bredesen's plan also requires all enrollees to use the lowest cost prescription drugs, and to buy basic antihistamines and gastric-acid reducers out-of-pocket and over the counter.
   Only a third of enrollees will be affected by the new strategy since the remaining two-thirds will be made up by children, pregnant women and disabled.
   According to Hyder, Tenn Care is unique, most states limit the amount of prescription drugs, but right now Tenn Care covers an unlimited amount of prescriptions. "Tennessee may rank number one simply because of Tenn Care; There is no magic bullet to solve the problem," said Hyder.
   Hyder also points out that if insurance doesn't cover a prescription patients are likely not to pay out of their own pocket, and simply do without.
   The study points out that many states with high drug cost burdens also endure high levels of illness, so using more medications than average is understandable.
   Even in states with high prescription drug use rates, especially poorer states and those with more uninsured, many people lack needed drugs. The report highlights that slashing use to reduce cost burdens is unsafe and unnecessary.
   Patients and taxpayers, particularly Tennessee, cannot afford to spend more. Therefore, the report concludes, "Cutting drug prices is the only practical way to lower drug cost burdens and expand use of needed medications."
   Sager and Socolar conclude that national or state reforms to finance all needed prescription drugs would be surprisingly affordable. They suggest price cuts to spur a large rise in the use of needed medications, partly by permitting better private and public coverage. Reforming legislation to fill in revenue gaps formed to protect drug makers' profits and research.