WASHINGTON, Nov. 10 (UPI) -- Seniors today have access to better rheumatoid arthritis drugs -- with more on the horizon -- than ever before, but they may not be able to afford them unless Congress passes a Medicare prescription drug bill.
Arthritis or chronic joint symptoms affect nearly 70 million, or one-third, of American adults, according to the Centers for Disease Control and Prevention in Atlanta. Americans are living longer into old age so that figure is expected to rise significantly.
Arthritis commonly is perceived as a disease of the elderly, but CDC information shows nearly two-thirds of arthritis patients are age 65 and under. Rheumatoid arthritis is one of the most common forms and is characterized by severe joint pain and inflammation.
Estimates from the American Academy of Orthopedic Surgeons show arthritis accounts for 750,000 hospitalizations, 36-million outpatient visits and, in 1995, reached $82 billion in medical costs and lost productivity.
Despite these staggering figures -- as well a current annual total of $17 billion spent on medications to treat arthritis -- a new report suggests both sufferers and drug companies may lose out in the struggle against the autoimmune disorder because America's aging population has dwindling financial resources.
The report, conducted by Kalorama Information, a market research organization in New York City, looked at various demographics of people ages 45 and up, the bulk of this group being the 76 million baby boomers, the largest segment of the U.S. population, born between 1946 and 1964.
Authored by Kenneth Krul, an independent research consultant in San Diego, the report, "Markets in Geriatric Medicine Volume I: Rheumatoid Arthritis," examined epidemiology, clinical and business trends. As the latest and greatest in rheumatoid arthritis therapies emerge, it concluded, patients likely will have trouble paying for them.
"The newer products coming out into the market and the new biotechnological therapeutics are now going to offer a great deal of hope for people with severe arthritis," Krul told United Press International. "The key is affording it. The assumption has been that, yes, we're going to get a lot of money out of this because the baby boomer generation will have that many more people to treat, but the problem with that is who's going to pay for it?"
Krul's study concluded over-the-counter and generic medications account for nearly two-thirds or 60 percent of the current arthritis market, indicating price is a key concern to arthritis patients.
An estimated two-thirds of America's seniors have incomes of less than $20,000 annually.
Treatments called anti-tumor-necrosis-factor injections are among the newest and most expensive. They involve a highly technique that reduces the inflammation caused by rheumatoid arthritis.
Dr. Hayes Wilson, national medical adviser for The Arthritis Foundation -- an organization heavily sponsored by the pharmaceutical industry -- and chief of rheumatology at Piedmont Hospital in Atlanta, said anti-TNF treatments can cost tens of thousands of dollars.
"I do have some patients who have paid for Enbrel out of their pockets," Wilson told UPI. Enbrel, an anti-TNF injection manufactured by Immunex Corporation of Thousand Oaks, Calif., is given twice weekly or eight times a month and can cost $15,000 per year, he explained. Other anti-TNF medications -- such as Remicade, by Centocor Inc., of Malvern, Pa., or Humira, by Abbott Laboratories of Abbott Park, Ill. -- can cost as much or more, depending on how high a dosage is required and how frequent treatment is needed. Wilson said his patients taking Humira or Remicade typically have insurance coverage to help with the costs.
"Unless you have a drug plan, that means you're sort of out of luck," Wilson said. "Part of the reason for the cost of these medications being so expensive is the research that goes into it -- and the manufacturing process is unbelievable. I think this is part of the healthcare crisis that we're all struggling with now, and it's not just arthritis medicines."
Medications for other chronic conditions, Wilson said, also could become difficult to afford.
Less expensive, but widely popular rheumatoid arthritis drugs include the non-steroidal anti-inflammatory pills Celebrex, Vioxx and Relafen. Many of these pills fall around an average of $100 per bottle. One hundred tablets of Relafen, manufactured by GlaxoSmithKline in Research Triangle Park, N.C., averages at wholesale for about $120, said Ramona DuBose, a spokeswoman for the pharmaceutical company.
Rising drug costs and an aging population struggling to pay for the treatments for a chronic disease, such as arthritis, is a major concern to the pharmaceutical industry, DuBose said.
"We're not just concerned about baby boomers in the future," DuBose told UPI. "We're concerned about people right now who have challenges paying for their medications."
Chris Loder, a spokesman for Merck & Co. Inc., in Whitehouse Station, N.J., said the patients would have fewer difficulties paying for treatments if Congress passed a drug benefit plan.
"Merck is supportive of a Medicare prescription drug plan," Loder told UPI. "We believe it's very important for Congress to adopt legislation." Loder added any legislation should "be a plan with a private sector approach so people can choose competing prescription plans -- as opposed to the government setting the (drug) prices."
Merck makes Vioxx, a widely popular arthritis treatment that belongs to a class of medications called Cox 2 inhibitors. Cox 2 inhibitors work by blocking an enzyme to prevent arthritic inflammation. Loder said "90 percent of patients get their Vioxx through a managed prescription plan."
Merck also hopes to enjoy similar success with another new Cox 2 inhibitor called Arcoxia. Loder said Arcoxia, which works like Vioxx, has been approved in 30 countries, but not yet in the United States. The company will submit an application for approval in the U.S. market by end of this year, he said. Loder declined to comment on any other therapies in development.
A spokeswoman for Pfizer Inc., in New York City, which manufactures another popular Cox 2 inhibitor drug, Celebrex, declined to comment, saying any comment on how rising drug prices might affect certain population segments would be speculative.
The House and Senate in June passed separate Medicare prescription drug bills and now a congressional conference committee is struggling to merge the bills into one final piece of legislation, which must then be passed by both chambers.
With only $400 billion over 10 years to work with, the Medicare drug legislation is heavily weighted to benefit the very low income and those seniors with catastrophic drug costs -- more than $4,000 per year. Middle class seniors might see only a limited drug benefit because the legislation likely will contain a coverage gap -- possibly a couple of thousand dollars -- during which they would have to pay all of their drug costs out of pocket.
There also is growing pessimism on Capitol Hill that a drug bill will be passed this year because Republicans and Democrats on the conference committee cannot seem to agree on language in the legislation that would make traditional fee-for-service Medicare compete with private health plans that bid for Medicare business.
Many pharmaceutical companies offer payment assistance programs for low-income individuals struggling to finance their treatments.
"Pharmaceutical companies can actually be very good about these things when medication is needed in certain cases," Krul said.
Wilson also commented that pharmaceutical company payment assistance programs can be an option to patients on limited budgets, though many of these programs are for the indigent and middle class patients may not qualify.
"A lot of drug companies have stop-gap measures, meaning they will provide medication on a compassionate basis for people who don't have the benefits," Wilson said. "(Such programs) are effective if patients have the perseverance to work through the red tape the drug companies make them go through."
With so few options to patients, Krul concluded in his report that a prescription benefit program to Medicare would significantly alleviate the situation. However, only individuals age 65 and older can qualify for the federal health insurance program, which might leave younger baby boomers out in the cold.
Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, a Washington, D.C.-based association representing drug and biotechnology companies, said government intervention is critical to resolving this healthcare crisis.
The baby boomers, Trewhitt told UPI, "will be a growing number of people retiring over the next 10 to 15 years. That fact simply underscores the need for Congress to reach a bipartisan agreement now on a Medicare drug benefit."
Medicare is mainly for people age 65 and older but Trewhitt said it's a starting point to addressing this problem. He acknowledged this does not help folks in their 50s, 40s and even younger.
"There are other patient populations lacking in insurance coverage and are on very fixed incomes. Forty-one million Americans are without health insurance."
Trewhitt said patients should be more assertive in asking their physicians for free medication samples to help offset the drain on their wallets. Drug companies, he said, give "$10 billion to $11 billion a year in free samples to doctors. They can always ask their doctor for free samples."
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Katrina Woznicki covers medicine and health issues for UPI Science News. E-mail [email protected]
