Consumer advocacy group Families USA has claimed that prices for the 20 medicines most-prescribed for US seniors are 58% higher under the Medicare prescription drug benefit than when they are provided by the Department of Veterans Affairs (VA).

Families USA issued its report shortly before the House of Representatives was due to vote on a bill to end the current ban on the federal government from negotiating drug prices and a Senate Finance Committee hearing into this issue which is set for today.

In its report, Families USA examined the prices which are charged for the 20 drugs by the VA and also by the five companies which have the largest enrolments in the Medicare drug benefit programme. These firms are UnitedHealthcare/PacifiCare, Humana, Wellpoint, Member Health and WellCare.

Families USA says it has found that the prices charged by plans sponsored by the five companies are:

- 50%-75% percent higher than the VA price for Pfizer’s anti-inflammatory drug Celebrex (celecoxib);

- 51%-82% more for Pfizer’s lipid-lowerer Lipitor (atorvastatin 10 mg);

- 69%-95% higher for AstraZeneca’s Nexium (omeprazole), used to treat heartburn and acid reflux disease;

- 205%-261% more for Merck & Co’s osteoporosis treatment Fosamax (alendronate);

- 435%-522% higher for Wyeth’s gastrointestinal agent Protonix (pantoprazole); and

- 1,066%-1,229% for Merck & Co’s lipid-lowerer Zocor (simvastatin 20 mg). A generic version of Zocor became available in June 2006, but the lowest price offered by the top insurers for the generic equivalent is still 706% higher than the lowest VA price for brand-name Zocor, says the report.

“These high prices devastate seniors who need to take multiple medicines, especially when they reach the coverage gap known as the ‘doughnut hole’,” commented Ron Pollack, executive director of Families USA. “They are also a rip-off of American taxpayers, who pay for three-quarters of the costs of Medicare Part D [the prescription drug benefit],” he added.

However, the Pharmaceutical Research and Manufacturers of America (PhRMA) has attacked the Families USA report. “The truth is this programme is providing better access to medicines for seniors and the disabled while costing taxpayers much less than anticipated. Just a few years ago, barely half of America’s seniors had prescription drug coverage; today more than 90% of them do,” said PhRMA senior vice president Ken Johnson.

Families USA’s support for the government to be empowered to negotiate prices for the drug plan ignores two crucial facts, according to the industry group. First, it said, private plans are already achieving significant savings from pharmaceutical makers and second, when governments set drug prices, patient choice vanishes.

“Allowing the federal government to negotiate drug prices would, according to experts, lead to restrictive formularies and keep patients from getting the medicines their doctors prescribe. While Medicare Part D plans in 2007 cover 4,300 prescription drugs on average, the VA plan includes only around 1,300 prescription medicines,” said Mr Johnson.

Of the 300 drugs examined in the Families USA report, only 65% are included in the VA formulary, compared to the 95% covered by the largest plan in the Federal Employee Health Benefit Program (FEHBP), which provides coverage for Members of Congress. Additionally, out of 132 brand drugs among the top 300 drugs, just 42% are covered by the VA formulary, compared to 95% covered by the FEHBP formulary, he added.

“No one wants a one-size-fits-all solution when it comes to protecting their own health or the health of their families. The Medicare prescription drug benefit is working because it recognises that beneficiaries have individual health needs. Any solution that puts the government at the pharmacy counter to second-guess doctors and limit patients’ choice of medicines is hardly the solution that the vast majority of Americans want when it comes to their healthcare,” said Mr Johnson.

By Lynne Taylor