Reaction to Wal-Mart Drug Plan Varies
FARAI CHIDEYA, host:
Florida Governor Jeb Bush reportedly calls Wal-Mart's prescription drug program "good corporate citizenship." Others say the plan will hit retailers and small businesses hard. Now with more on discount-drug retailers is Dr. Gary Puckrein, executive director of the National Minority Health Month Foundation based in Washington, D.C.
Good to have you on the program.
Dr. GARY PUCKREIN (Executive Director, National Minority Health Month Foundation): Hi. How are you?
CHIDEYA: I'm great.
Dr. PUCKREIN: Great.
CHIDEYA: Also on the line, we've got Dr. Gail Christopher. She's vice president of the Joint Center for Political and Economic Studies, Office of Health, Women and Families. It's a pleasure to have you with us as well.
Dr. GAIL CHRISTOPHER (Vice President, Joint Center for Political and Economic Studies, Office of Health, Women and Families): It's a pleasure to be here.
CHIDEYA: So, Dr. Christopher, how big of a deal is this dramatic slash in drug prices?
Dr. CHRISTOPHER: It's a pretty big deal I believe, particularly for those who might be caught in the donut hole of the Medicare prescription drug plan. And when you consider that communities that are served by Wal-Mart, I think it will have an impact on the marketplace. Now I don't think it will have a dramatic impact on health disparities because, you know, one has to go to the doctor first, and it's the lack of insurance that keeps the person from going to the doctor to get the prescription. But it is a good step in the right direction.
CHIDEYA: We just heard from Bill Simon of Wal-Mart and he too mentioned this donut hole. Can you explain what that is?
Dr. CHRISTOPHER: Well, there's a point in the Medicare Part D plan where individuals actually will have to pay a hundred percent of their drug costs. Now those with the lowest incomes are going to be protected. But the middle-income group will end up having to pay a hundred percent until they reach a much higher threshold for drug expenses. So for those, being able to access generic drugs at that kind of discount will probably be beneficial.
CHIDEYA: Dr. Puckrein, how important are the drugs that are being offered to the African-American community? Are these drugs that are used very often by African-American and other ethnic communities or is that sort of not taking into account in the choice of drugs that are offered as this $4 generics?
Dr. PUCKREIN: Well, generic drugs are actually a mixed bag when it comes to the minority community. The problem really starts very early when they will brand a drug, meaning they were under patent. The problem that we have is there are not a lot of minorities in the clinical trials that lead to these drugs. So whether the drug becomes a generic, what you then have is health plans, in the (unintelligible) of dollars, make these drugs available as the first choice.
And it doesn't take into account that, you know, drug's variability, that these drugs may not be as effective in certain populations. And you end up with what's called step therapy: The patients are asked to fail on that medication before they're offered maybe a branded drug, which could be more expensive.
CHIDEYA: Now along those lines, generics reportedly accounted for 57 percent of all the prescriptions sold in the United States and 13 percent of sales. That's according to a health care information company called IMS Health. I guess the disparity between the 57 percent of prescriptions and the 13 percent of sales is about price. Is that correct?
Dr. PUCKREIN: Yeah. At the surface it's about price. But you got to understand what drug development is in this country. We rely on pioneering companies to create new therapies. And the peculiar-ness of our system says that basically 18 years roughly after a drug has been discovered it comes off patent and then becomes this generic drug.
And so what's being offered to patients is in some sense old technology. And because of the desire to save dollars, patients get offered this old technology. And in some instances not made available to them are some of the newer technologies. So it's a real mixed bag about generic drugs that sometimes get lost when we just think of cost.
CHIDEYA: Dr. Christopher, you know, Dr. Puckrein is calling this a mixed bag. How do you take a look at this at how it's going to ultimately affect consumers?
Dr. CHRISTOPHER: Oh, I think he's right. It is a mixed bag. The African-American response to pharmaceuticals is different, it is unique, particularly in relationship to inflammatory processes, which tend to under (unintelligible) or be involved with many of the chronic diseases from which we suffer a disproportionate burden.
So it will have to be monitored carefully. And what comes into play here is the relationship between the doctor and the patient. And there again we face the real problem, which is access to insurance and access to quality care. Having access to the pharmaceutical particularly if it is a generic, if it's not a brand, requires more careful oversight by the doctor.
CHIDEYA: You both have been on the forefront of issues as they relate to the health disparities movement. And ultimately I guess my final question, and I'll start with Dr. Puckrein, is will we see gaps in coverage close because of more programs like Wal-Mart's and Target's, or are we still going to be left with a lot of these underlying health disparity problems?
Dr. PUCKREIN: Well, I think surely programs like Wal-Mart will provide some benefit to patients in terms of making drugs available. But the question is, are they the right therapy? I mean that's just as important. We can't lose sight of because of cost that we're giving a patient the drug that may or may not be as effective in them, so.
I think Dr. Christopher is absolutely right. This is really a conversation between the patient and the physician, and we need to be careful that we don't interject cost into that discussion to the disadvantage of the patient.
CHIDEYA: Dr. Christopher?
Dr. CHRISTOPHER: I think it is important that the market forces will be used to leverage better prices for consumers. And Wal-Mart has done what our federal government didn't do in terms of using its muscle in the marketplace to do something to help regulate or control or even bring down prices. So that is a step in the right direction.
But we are a long way from addressing the disparities because ultimately we need universal access to health insurance. And that's what, you know, the doctor is still the gatekeeper. You aren't going to get the prescription unless you've seen the doctor. And our people are not seeing doctors because they can't afford to.
CHIDEYA: Dr. Gail Christopher is vice president of the Joint Center for Political and Economic Studies, Office of Health, Women and Families. And Dr. Gary Puckrein is executive director of the National Minority Health Month Foundation. Thank you both for joining us.
Dr. PUCKREIN: Thank you.
Dr. CHRISTOPHER: Thank you.
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CHIDEYA: Coming up, Condoleezza Rice defends the White House efforts to catch Osama bin Laden, and Oprah Winfrey comments on why folks who work for her are mostly white. We'll discuss these and other topics on our Roundtable next.