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| America’s borders are busy. To the north, buses full of senior citizens regularly cross into Canada, where passengers embark on shopping sprees for prescription medicine. To the south, people on fixed incomes often drive to Mexico to pick up blood pressure pills, emphysema inhalers and just about any other drug their doctors order. Although prescription drugs can be found elsewhere for a fraction of the price that they command in the United States, the practice is fraught with potential problems. "We hardly ever know what medication or dose they’re on because there’s no regulation," said Pat Gillett, MSN, FNP. Gillett practices in the pulmonary section of the Veterans Administration Hospital in Albuquerque, N.M., a regional center that serves such a wide swath – all of New Mexico, a large area of Texas, and parts of Arizona and Colorado – that many patients must drive 600 miles to see their doctor. Because the federal government no longer reimburses travel expenses for less than 200 miles, many patients opt instead to make a quick dash across the border. "I have patients who go to Mexico to get their medicines all the time, and the big problem is that they don’t want to tell you," Gillett said. "I just happen to look into the computer and see they haven’t refilled their medication in months. And when I look at the bottles they bring me, I don’t recognize any of the labels." When a 60-year-old patient recently complained that his emphysema had become worse, Gillett asked to see his medicine – an albuterol metered dose inhaler purchased in Mexico. She immediately ordered a new one from the local pharmacy, and within two weeks his health had improved dramatically. The key, nurses say, is to ask a lot of questions without appearing to pass judgment. "Patients are embarrassed to talk about finances," said Mary Rapp, MSN, RN, president-elect of the National Conference of Gerontological Nurse Practitioners. "They need to feel safe enough to tell you that they only take the medication five days a week or every other day. I tell them, ‘We treat you based on what we think, and if it’s different you need to let me know.’ So you ask specific questions: How many doses did you miss? How many days did you not take your medicine? Do you use the same pharmacy or different pharmacies?" Of course, senior citizens aren’t the only Americans affected by the high cost of prescription drugs. In the Southwest, nurses say it isn’t unusual to find parents traveling to Mexico to buy affordable antibiotics for their children. But because so many elderly people live on fixed incomes – and because they often require multiple medications – they bear the brunt of rising drug costs. Health plans contend that prescription drugs are the most rapidly increasing component of their costs, accounting for more spending than hospital care. The pharmaceutical companies counter that newer, better drugs help offset other medical costs, and that direct-to-consumer advertising is dictated, at least in part, by federal guidelines on education outreach. But why should drugs cost so much more in the United States than in Canada or Mexico? "That’s a question we’ve been asking," said Steve Hahn, spokesman for the American Association of Retired Persons. "The pharmaceuticals say they need money to cover the cost of research and development, but then they spent a billion dollars the first half of last year in advertising – mostly for glamour drugs like Viagra." "I think they spend a lot of money wining and dining doctors," said M.J. Henderson, MS, GNP, RN, a geriatric nurse practitioner in Los Gatos, Calif., who routinely gives free samples to patients who cannot afford prescription drugs. "And now they’re trying to target nurse practitioners, inviting us to fancy dinners and lectures. I don’t go. My response is, ‘Make your drugs cheaper, and if you want to do education, why not come to our next convention and buy a booth?’ And I have to admit, some of them have done that," Henderson said. The issue is heating up on Capitol Hill, where President Clinton is threatening to veto a $40 billion Medicare drug plan recently passed by the GOP-controlled House. Clinton and other Democrats favor a plan that would cover half of seniors’ drug costs up to $5,000. Such a plan would go a long way toward helping the 66-year-old father of Ja-Net Nash-Dotson, MS, MPH, FNP, RN. Her dad is a retiree who needs a daily immunosuppressant drug to prevent rejection of the kidney transplant he underwent in 1995. But the cost, $950 a month, is three times his mortgage payment, and that’s only one of several medications he must take. He recently qualified for a patient assistance program that reduced his monthly drug bill from $4,000 to $700. Such assistance is available to indigent patients around the country, but few know about it. Fortunately, Nash-Dotson is a nurse practitioner who has had plenty of experience seeking financial help for her patients. "Both my parents are on a fixed income with no other resources," said Nash-Dotson, who delivers primary health care to low-income residents in southern Dallas from a mobile van. "They’ve worked all their lives, they’ve put five kids through college. You’d think there’d be more help out there and there’s not." |
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