Some people with disabilities are having to choose bills over needed medicine

From The Record in Hackensack, NJ:

HACKENSACK, N.J. — When Ruth Williams' health plan stopped paying this past summer for the daily medication that slows her multiple sclerosis, she couldn't afford its $1,000 a month price tag.

It was a choice between electricity — the power company sent a shut-off notice — or medicine. The power company won.

Williams, 43, soon noticed her symptoms worsening. The tingling and numbness that had been confined to her fingertips after four years with multiple sclerosis climbed to her elbows.

"I used to type away, and then I realized I was making more mistakes than actual words," she said.

It was the same with her feet: First, she had frozen toes, then the bottoms of her feet tightened and soon her lower legs were stiff.

"I knew I was putting myself in a position where it would be harder to do what I have to do for my family," said Williams, who has a 10-year-old son. "I need my hands and feet. But what money I did have just went to pay the bills."

This year's economic woes have forced a terrible trade-off between short-term savings and long-term consequences for some people with chronic diseases. Medications are often their first cost-cutting target when it comes to medical care, because many pay a large share of their costs out-of-pocket. Some lack any coverage for drugs at all.

About one in four Americans report they did not fill a prescription in the past year and nearly as many said they had cut pills or skipped doses to save money, according to a Kaiser Family Foundation poll.

"I've never had so many phone calls from people asking if they can switch to a generic," said Dr. Joseph Friedlander, a Teaneck, N.J., internist. "Or they ask if there are samples from the drug company that will help them."

Friedlander said he's seen patients who had controlled their blood pressure successfully for years start spacing out their daily hypertension medication to once every three days to cut expenses. "Now their blood pressure is markedly elevated," he said.

"You have to educate your patients that it's in their best interests to stay on schedule," he said. "If you don't take your blood-pressure medication to save $30, and have a stroke, that's going to cost you more — that's going to hurt you for the rest of your life."

Not all can be genericAt Holy Name Hospital's comprehensive multiple sclerosis center in Teaneck, where Williams is treated, doctors also are seeing more patients struggling to pay for medications.

"We have many more patients asking for generics, but they're not available for the injectables," said Dr. Mary Ann Picone, the center's medical director.

When patients stretch their medicines out or stop refilling prescriptions, said Picone, "that puts them at higher risk for worsening symptoms."

Williams had injected herself once a day with Copaxone to keep the symptoms of MS from advancing.

After numerous appeals, the health plan started paying for — and Williams started taking — her Copaxone again after a three-month hiatus.

For people over 65 with no employer sponsored coverage, Medicare's Part D, launched in 2006, has provided a partial safety net. It defrays the costs of many of the drugs that seniors need. But this is the time of year when heavy users of prescription medicines have hit the "doughnut hole" — the coverage gap created by Congress, when most beneficiaries pay all prescription costs themselves.

This year, the doughnut hole began when a beneficiary's total drug costs exceeded $2,511 and continue until costs reach $5,726.25.

Vincent Nuccio, 74, of Fort Lee, N.J., is in that coverage gap; his wife entered it in June. His wife's osteoporosis medicine costs $900 a month, which they paid themselves for the past few months. When the couple celebrated their 50th wedding anniversary in September, he said, "We didn't even go out."

More than half of all insured Americans take regular prescription medications, most commonly for high blood pressure and cholesterol. About one-quarter of seniors take five or more medications regularly.

Ruth Williams lost her part-time job at a pharmaceutical company. Now she's worried about what will happen when her divorce goes through and she no longer has health coverage from her husband.

"It just seems like there is no safety net," she said.