Audrey Browne helps defend the prescription drug plan run for the American Federation of State, County and Municipal Employees union in in New York, District Council 37 to be precise.
"We are like a lot of plans, struggling to keep our heads above water," she said.
The plan has 313,000 members, many of them working poor, so drug benefits in a health plan matter.
But, Browne argues, even the poorest members of the group need to be aware of costs, use generic drugs when available and skip brand-named drug coupons. Otherwise, the whole plan will eventually collapse.
Browne's plan was one of those filing suits Wednesday against eight pharmaceutical companies, alleging that the coupon plan is illegal and eventually raises the cost of health care for all. AFSCME District Council 37 was one of the named plaintiffs in the suit filed in the Eastern District of New York against Amgen and Pfizer.
Pfizer's coupon program for its $9 billion cholesterol drug Lipitor has been among the most prominent. The coupons are Pfizer's attempt to keep as much of that revenue as it can after losing complete patent protection in the United States in November 2011.
The Inquirer story in Thursday's paper is here.
Browne explained that even if the co-pay coupon gives the patient Lipitor for $4, Pfizer still charges the health plan and the other parties in the payment process about $180.
"Lipitor is the No. 1 drug utilized and it makes up the lion's share of what we spend money on," Browne said. "When people used the generic statins, with a generic co-pay of zero, our costs dropped by $7 million."
Browne repeated a common complaint about the U.S. health-care system, which is that most patients have no idea what care costs, drugs included, so they are less careful about using the system. If people know the cost and have to bear some of the cost, they will make different decisions sometimes.
"If you're in the market for a new car, you can go on the Internet and find the base cost for every car and the cost for every feature," Browne said. "But you have almost no idea about the cost of a drug. If you don't know the cost of something, will it influence your decision? Sure. We all need to be better consumers."
"But until the revolution," she said with a chuckle, "we have to be smart about benefits and how we use them."
On the other hand, Pfizer spokesman Chris Loder defended the Lipitor coupon program and said the company will contest the suit.
"Pfizer encourages patients to talk with their doctors about available treatment options and is committed to helping patients better afford Pfizer medications," Loder said in a statement. "An example of our commitment is the distribution of co-pay coupons and co-pay cards.
"Pfizer supports individualized treatment choices by physicians and their patients. Given the larger cost-sharing burden being placed on patients, Pfizer supports the use of company sponsored programs which help patients with out-of-pocket expenses for the medicines prescribed by their physician. Redemption of our coupons and co-pay offering requires a valid physician prescription.
"While many health plans have raised their co-pays and/or are encouraging switching to generic medications to achieve cost-savings, these treatments may not be appropriate for all patients. The purpose of co-pay cards is to support the medical treatment choices made by prescribers by better enabling patients to afford these medications.
"Finally, in addition to our brand coupon and co-pay programs, Pfizer runs the largest and most extensive family of patient assistance programs in the U.S. and is committed to ensuring that eligible patients who need our medicines have access to them."