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February 20, 2002

Host: Michael Grant
Topic: Prescription Prognosis, a special three-part series examining the costs of prescription drugs
Tonight's episode "Future Legislation"
In-Studio Guests: Grant Smith, Capitol Times reporter;
Lupe Solis, assistant state director for advocacy for the AARP;
State Representative Deb Gullett

>> Reporter: We're paying three times more money for prescription drugs than we were ten years ago.

>> I think they're exorbitantly high, myself.

>> Reporter: Some go to another country to save.

>> Well, we save a lot of money on our prescriptions, that's for sure.

>> Reporter: Others turn to the web.

>> If you purchase drugs on the Internet, it's quite a bit different than purchasing shoes or a car or computer.

>> Reporter: Some spends hundreds of dollars a month.

>> But it's the higher priced ones that really hurt.

>> Reporter: "Prescription Prognosis," a "Horizon" special on the high cost of prescription drugs.

>> Michael: Good evening, I'm Michael Grant. Monday we talked about how you can buy prescription drugs in Mexico. Tuesday we told you about some of the pitfalls to avoid when shopping for medications on the Internet. Tonight on "Horizon," the final part of our series on prescription drugs. We take a look at how public policy can shape what consumers pay for prescription medication. Legislation on the state and federal level has been proposed to help with the cost of prescriptions. In a moment we will talk about some of those proposals but right now all regular session business has been halted at our state legislature. That's so lawmakers can resolve the state budget crisis, or at least try to. Here now to talk about that, capitol times reporter Grant Smith. They trying hard?

>> Grant Smith: Well, they're trying hard but they're not making much progress. They had a deal in the Senate, they thought, that was going to go this afternoon and it fell apart before they could get it to the floor.

>> Michael: What happened?

>> Grant Smith: Well, at the last minute Jim WEIRS, the house speaker, came over to the Senate and said, well, let's see if we can put some compromises into this Senate deal that the house would find acceptable so that the legislation could just go sailing through both the Senate and the house. And the big stumbling block on any kind of resolution at this time is the pay raise for the state employees. The house has not wanted any pay raise, has been against -- I should not say they have not wanted, because they would like it, but they say the state cannot afford it.

>> Michael: Right.

>> Grant Smith: And the Senate, the majority of the Senate, wants to keep the pay raise. So it was the big stumbling block, and they tried to do -- tried to work out an arrangement to perhaps cut the pay raise in half and delay the start of it to ease the impact on the budget this year and also ease the impact of it -- on it next year.

>> Michael: Yeah, the basic plan there, as I understand it, at least possible plan, being a two-and-a-half instead of a five percent increase, and it locks in June 15, so it has minimal impact on this fiscal year and obviously reduced impact next fiscal year.

>> Grant Smith: Right. And they got into the negotiations, and the Senate Democrats said, no, we're not negotiating on this at this time. And afterwards, jack Brown, the democratic Senate leader said he felt that he only wants to negotiate once, and he felt if that they negotiated this time, that he'd have to be in after a Senate bill was passed to negotiate again and he's not going to do that. And he wants to put his -- the deal that they've got on the floor and vote on it. But that may not come for a while.

>> Michael: Grant, placing the pay increase issue to one side, and that's tough to do, because it clearly is driving just almost all of this, but the House plan also has, then, some additional budget cuts, does it not, that the Senate plan doesn't have?

>> Grant Smith: Right. The House plan carries a .5% budget cut for state agencies with the exception of the department of education, the school for the deaf and blind and some AHCCCS programs. That would extend to the universities. So that was not in the Senate plan.

>> Michael: The Senate, on the other hand, still sweeping funds and stuff like that -- I would think that we would be running out of broom here, but they've got some of these funds sweeps --

>> Grant Smith: It's amazing where they come up with them at times. There are a lot of them out there, yeah. One of the places to get big hits would be the school facilities boards funds which were the students first funds for building renewal and for new school construction. And the Senate was going pretty strongly into that. What they are trying to do is get a schedule from the school facilities board on when new schools will be constructed and how soon any funds that they might take out of that would be needed to pay for the new schools so that they're trying to do it without stopping construction, but -- who knows?

>> Michael: So in the meantime, everything shut down -- anything scheduled at this point -- regular session business is not under way.

>> Grant Smith: No.

>> Michael: Is there anything scheduled on the budget for the next step?

>> Grant Smith: The House has been holding joint sort of briefing sessions on -- for example, today basic aid to education was discussed in a joint caucus in the house, and the Department of Transportation budgets, yesterday AHCCCS people came in and discussed AHCCCS programs and the prop 204 programs which expanded AHCCCS coverage to families that d at 250% of the federal poverty level.

>> Michael: So basically they're using it for some deep background stuff --

>> Grant Smith: Right.

>> Michael: -- but in terms of trying to move this thing out of the Senate, beyond the Senate, those kinds of things, anything scheduled or are they just deadlocked at this point in time?

>> Grant Smith: They're just at a deadlock, and the house is saying, well, we have to decide what is going to happen in the 2002 budget before we can really go to the 2003 budget, because, for example, if the pay raise stays in there, that's $100 million that has to be dealt with.

>> Michael: In the meantime, when we suspend all regular session business, that starts backing up all the various deadlines. You were saying how many bills were scheduled to be heard this week?

>> Grant Smith: About 250 by our count on various committee schedules, and those won't be heard until next week, if the session really gets going next week, and we are reaching a point where they're going to have to change some every their deadlines on hearing bills because at a certain date it's cut off that house bills can no longer be heard by house committees, Senate bills can no longer heard by Senate committees and right now that deadline is two weeks away. Well, they're probably going to have to move that back.

>> Michael: Right. We're going to be talking to representative Gullett in a secretary on her prescription medication. What's its current status, grant?

>> Grant Smith: Her bill, which sets up a drug advisory council to assist people in getting free drugs, has passed the house by a 56-2 vote, very nicely and it's over in the Senate.

>> Michael: Suspended!

>> Grant Smith: Waiting for whatever happens there.

>> Michael: Regular session business. Grant, thank you very much for the information.

>> Michael: In 2000, 44 million prescriptions were filled in Arizona. The average cost... about 45 bucks in that a time of budget cutbacks, human service programs are being targeted for reduction. Can public policy be implemented to help cure the high cost of prescription drugs? Where will funding for a prescription drug program come from? What state and federal legislation somebodying prescribed for that problem? In a moment we will talk about than. First, merry Lucero has this report.

>> Reporter: Mike most seniors, Marian Scott is on a nid income. She makes under $25,000 a year and must budget her dollars wisely. Also, like many seniors, Scott is finding her golden years are bringing some not so golden health issues.

>> Marian Scott: The biggest thing that took me to the doctor was the swelling in my feet, ankles, legs, and as it turned out, I had congestive heart failure, plus I had a heartbeat that wasn't right. So I had atrial fibrillation, and so as a result of that, I had a cardioversion done about a month ago that they shocked the heart.

>> Reporter: The procedure was successful, but then came another shock.

>> Marian Scott: $71.99 for one prescription. You know, that's a lot of money. Then I have the Accupro which is for blood pressure, and that runs $58.24.

>> Reporter: The slew of medications prescribed for her condition. In all she pays about $300 a month for her prescription drugs, with insurance.

>> Marian Scott: And you wonder, where does this end? And when do I have to make choices about whether I buy my prescriptions or I buy groceries, because it could happen.

>> Reporter: Marian's granddaughter Mary worries.

>> Mary Scott: If you have to spend so much on prescriptions, then she might not have a lot of money in case an emergency did come along to be able to cover that.

>> Reporter: Marian like many is hoping public policy can help with the high cost of her prescription drugs.

>> Leah Landrum:: And it starts right here! It starts with responsible legislation to make sure that the voters have an opportunity to say, you know, we would like to participate in that.

>> Reporter: State representative Leah Landrum: Taylor and Linda Lopez are rallying support for their bill a voter referendum for an income tax increase would that cover seniors' prescription drug costs through AHCCCS.

>> Leah Landrum: Right now we're having a very tougher time that with our budget and we don't want to just have it here are some budget cuts whether you like it or not. We don't know if the programs are necessarily good or bad for different individuals that we're cutting and we're not asking them. Now we have a chance to ask the public what is it that you would like to do to give you a choice, would you like to support a program to support our seniors with prescription drug coverage.

>> Reporter: But it is those budget troubles and politics that has the bill at a standstill blocked from a hearing by house, ways and means committee chair Steve May.

>> Steve May: If the Democrats want to have a serious conversation about providing prescription drugs to needy people in Arizona, they should do that. But they don't want to talk about that. They want to talk about raising taxes. We cannot raise taxes in a recession on young working families. We should find a way to provide prescription drugs for the elderly other and needy people but we're not going to do witness this plan.

>> Reporter: State lawmakers say it is a federal problem. President Bush has proposed Medicare prescription drug coverage, but for those in need of help with the cost of prescription medications now, that could take too long. In the meantime, many are counting on any help they can get with their prescription drug costs.

>> Michael: Joining me now to talk more about prescription drug legislation, state representative Deb Gullett, sponsor of a bill to create a state prescription drug advisory council. Also with us Lupe Solis, assistant state director for advocacy for the AARP. Hello to both of you. Representative Gullett, I recall talking to you sometime around this time last year --

>> Same time.

>> Michael: Was it a rural catastrophic type plan?

>> Deb: It was. A wonderful program that was passed and signed into law to create benefit for people with catastrophic drug needs who live in rural parts of the state. Places where the Medicare HMOs have moved out of the state and they have no help. So my bill would have had the state pay for Mav their prescription drug needs. It was a wonderful program and it broke my heart because we had to eliminate the funding for it in the special session last year.

>> Michael: I take it, Lupe, that the AARP was supportive of that proposal as perhaps -- at least a step?

>>Lupe: Of course. AARP's top pry tore tea is a prescription benefit under Medicare and so prescription discount programs are not a substitute for the -- to meet overall need but certainly it was a step and we have applauded representative Gullett's efforts to stay with the issue because certainly the need has not gone away.

>> Michael: Let's see if the echo of applause is carrying over into this year. Your current bill would create a prescription drug advisory council. What's that and how would it help?

>>Deb: Essentially what we want to do is bring together all of the players in the prescription drug world, the senior citizens, the consumers, pharmacists, drug manufacturers and the State of Arizona in an effort to help people take advantage every free prescription drugs that are currently available from the drug companies. Pfizer, for example, last year gave out $250 million worth of free drugs, not very many of them in Arizona because we don't have a mechanism to help people take advantage of these programs. So --

>> Michael: Is this just a corporate outreach program by Pfizer and other pharmaceutical companies?

>> Deb: 60 different drug manufacturers in America give out free drugs to low-income people or people with emergency needs. It's hard to qualify. Doctors have got to fill out a different form for every company. Some companies have different requirements that people have to meet. So our idea is, and we stole this from Maryland and Georgia and South Carolina and some other states that really are doing a wonderful job of trying to create sort of a one-stop shop for people. Our idea is we'll put this council together and charge them with coming one a not-for-profit program. I think we can raise some grant money in this tight budget time. I know there's no state money available currently. Other states have state funds available, and they're bigger programs, but they started out this way, and try to help people take advantage every what's there. It's a practical solution to a problem, but it is not as, Lupe said, a benefit.

>> Michael: Understood. Lupe, Representative Gullett showed me a map of the Pfizer system, I think, and it had dots all over it in terms of where they dispense this $250 million or so and there were only three in the state --

>> Lupe: And, of course, Pfizer has come one a different program where you can buy your programs for $15, but part of the problem is in the very nature of the programs and that is you've got 60 different programs, 60 different eligibilities and 60 different means of entering the program, and furthermore, the willingness of the medical community to help you attain entrance to a program is not assured by any means. And so one of the problems we see with the bill, though we're supportive of the concept, is that it doesn't do enough to guarantee that a person who, as you know seniors have an average of -- need an average of five to seven prescriptions a day, that a person that attains entrance to one of the programs is going to necessarily be able to fulfillment for the rest of their prescriptions.

>> Michael: Why would the medical community be assistant to --

>> It is paper work. It is paper work. And it is -- some of them are right now charging patients just to fill out their insurance forms. Do you think they're going to want to do much more for seniors when they're not being paid in any way? What the proposal -- while the proposal is a good one, we feel that it entails a lot of responsibility on a body that has no funding. The measurement of whether Maryland's and South Carolina's and others are working just really varies. Some people say it's working very well, and then you touch base with someone else and they say it's not so well.

>> Deb: We have the support of the Arizona medical association, and the idea is, this is one of the ones that really is working in Maryland, they've created a software program so they can somehow merge all of the applications, you fill out one application, the doctors fill out one application and then either through staff in some places or volunteers as we envision in Arizona make people eligible and make it easier to take advantage of these programs and I have received assurances from some of the drug companies that that's what it's going to take to get them to make a more serious commitment to providing free medication in the state. If we just make it easier for the doctors, for the patients, for the consumers. It is not -- it is, I think, a practical idea that can work. It is not a prescription drug benefit, though.

>> Michael: What about the legislation mentioned on Mary's -- Mary's tape piece about raising income taxes?

>> Lupe: Certainly that's probably -- the judgment on that one is still on the table. It has not come forth for a hearing, but AARP generally believes that taxing in that manner is very inflexible and it doesn't allow you to do changes when circumstances change. Also it says nothing about who is going to be paying for whose prescriptions. So I would say that at this time we've -- we're conducting analysis of it but we see a lot of hurdles for it.

>> Michael: I would assume maybe a couple of political hurdles?

>>Deb: It is -- I mean, they're trying to do the right thing and that is to help people who desperately need help with their prescription drugs, but I think as Steve may said in the article, I don't know that there is sentiment for tax increase and we ran the numbers on what this would mean. It would be the biggest tax increase in the history of the State of Arizona, larger than prop 301, the half cent sales tax increase for education and more onerous on families and I don't know appear family wants to pay 200 or $300 a year to provide this prescription drug benefit. So I don't think it's practical from that perspective and then add the 40-vote requirement to get it through the house. I don't know that there is a sentiment there. I don't think it's being held up specifically -- everything's being held up right now.

>> Michael: I'm going to ask the question that I think a number of people at home would like to ask. Why not simply mandate HMOs to give a prescription drug benefit of, here, fill in the blank, $3,000 a year? Why not do that?

>> Lupe: Well, first of all, you would have to get that -- for seniors it would have to come through the Medicare program and that's what we're working on, a Medicare prescription benefit under Medicare, but we need to make sure it's affordable and it's voluntary, because some people do have benefits already and they need to say yea or nay to entering a program like that. But also I think that some of the issues that come along with that is that we need to make sure that Medicare prescription benefit is going to have a limit or -- on out of pocket costs. We don't want to just mandate a program that's going to be insufficient to the need and certainly the president's proposal right now of $150 -- $190 billion is not even the $300 billion that was discussed last session. So we're not going forward. We're going backwards. So I think there's loft hurdles there, too.

>> Michael: What about the prescription drug discount card? Senator Comiskey has some legislation along that line?

>> He does.

>> Michael: What does that do?

>> Deb: It would -- for anybody, not just a senior citizen, I understand, but for anybody in the State of Arizona, they could become qualified based on their income, get a card, hand it into the pharmacy and get the same discount that people who are Medicare beneficiaries get, that's a rate the federal government negotiations with the drug companies, so say if the Medicare raid --

>>Deb: Medicaid.

>>Deb: Medicaid. I'm sorry. $40. Somebody who is not eligible for Medicaid would be able to buy that prescription drug for $40. The bush administration has already announce add waiver program to do that. In Arizona we don't have a mechanism, we're not equipped to make people eligible and that's what I think the challenge will be. The idea is something that senator Comiskey has worked on and that the bush administration has embraced. Illinois is the first state to get this waiver and they have pass add sales tax increase in Illinois for $32 million to help create an infrastructure. So that's what we don't have here. I don't know how we create that infrastructure to make people eligible and to create the program but it's something that the bush administration has embraced and it's a good idea.

>> Michael: It sounds like you're tapping into something that already exists --

>> Lupe: Well, as representative Gullett points out, I think the difficulty for these proposals would be the implementation because as AHCCCS exists right now it's not an easy implementation by any means. And also can have different repercussions. Now, on the other hand, I think any state that is looking, and we are certainly looking at the need, you just mentioned $44 million in prescriptions are -- we're talking lots of money here, but we're also talking about specific need and there are people with very high prescription costs that need immediate assistance as well as very low income people, especially in the rural areas, that are doing without. I think it's a matter of values. What does the state want to pay for? What does the state make a commitment to and how do we pay for it? Eventually any program that gets approved without funding is bound for failure because it's not going to work. You know, you can't do something for nothing. That's about the size of it.

>> Michael: I have a notation here on rebate cards. How would that one work?

>> Deb: I think that's the same idea.

>> Michael: As the --

>> Deb: As the Comiskey -- but the president has also come out with a program to have the drug companies give, and this is a federal program that you can sign up and get -- sign up for a rebait program and get some sort of rebate, that's being challenged in the courts right now, but the other part of the president's program that Lupe is talking about would be a federal-state matching program. He envisioned the federal government paying 90% of the prescription costs and the State of Arizona picking up 10%. So for us -- and that would be out-of-pocket expenses for senior citizens.

>> But that's under Medicaid.

>> So we're still --

>> Lupe: 100% of federal poverty level, which you're talking about a very limited pool of people, which in Arizona, because of our HMO withdrawals from the rural areas of the state, there's a crisis out there. There's a real crisis. In fact, parts of Maricopa County could be considered rural, and people need assistance and it isn't necessarily going to come through a rebate if we don't have a system in place.

>> Michael: When you draw that distinction, the Medicaid program is essentially AHCCCS --

>> Lupe: AHCCCS is our Medicaid waiver.

>> Michael: Medicare obviously is the broader --

>> Lupe: The broader picture. And we keep telling people that state assistance programs are not a substitute for Medicare prescription drug coverage.

>> Michael: So what do we do? Do we pray for rain from the federal government?

>> Deb: I think there is overwhelming support in every state to encourage the federal government to do this. It is their obligation and responsibility, I believe. It looks like the way they're going the state is going to pay some share and we're going to have to step up to do it because our citizens have an incredible need.

>>Lupe: But just how long this takes is the question here, because I think also the states have a responsibility to assist those that are in dire, dire need and we have a lot of those in this state and state again -- it's a matter of priorities. You need to decide -- we the people in the state need to decide as a whole, what is it that we are bound to cover for others that are in need? And prescriptions is number one.

>> Michael: Lupe Solis, thank you very much for joining us. Representative Deb Gullett, good to see you again. In addition to the information Channel 8 is providing on ways to save money on prescription drugs, the "Daily News Sun" of Sun City has a four-page supplement with more ideas. For information on that call the Daily News Sun at 623-977-8347. And for more information about our prescription drug series, including transcripts of the program, please visit Channel 8's website at www.kaet.asu.edu. Click on "Horizon" and follow the links. Tomorrow on "Horizon," to observe black history month we take a look at black businesses in the Valley. Friday, please join us for the journalists round table edition of "Horizon." Thanks very much for being here on a Wednesday evening. I'm Michael Grant. Have a great one. Good night.