"It was drugs or food for us before we heard of these pharmaceutical company assistance programs," he said. "Will we have to make that choice again?"

As Medicare's drug coverage takes effect, the pharmaceutical industry has started scaling down its patient assistance programs. Two companies will no longer take applications from people over 65; others will help only seniors who don't enroll in the drug program.

Hardest hit will be seniors with incomes between $14,355 and $20,000 - people who qualified for assistance programs but make too much to get help with a Medicare drug plan.

The drug company assistance programs have been a godsend for people who don't have insurance and can't pay for their medications. They are especially valuable for people with chronic or serious illnesses who take expensive medicines.

In 2004, the assistance programs filled 22 million prescriptions worth $4.1 billion for 6.6 million people, according to the Pharmaceutical Research and Manufacturers of America. A quarter of those patients were 65 or older.

No one knows how many seniors will be affected by the industry's pullback, since some drug companies are still deciding whether to curb their assistance. But the programs are shrinking.

"This is going to be a devastating loss for seniors on fixed incomes," said Deane Beebe, a spokeswoman for the Medicare Rights Center, a consumer advocacy group in New York.

Industry officials say companies are bowing out of drug assistance for seniors because Medicare is stepping in with more comprehensive and convenient insurance coverage.

"Our programs were always intended as a safety net, but Medicare is taking over that role for older Americans," said Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America.

Industry leaders such as Eli Lilly & Co. and GlaxoSmithKline have announced that people 65 and older won't be able to participate in their assistance programs after Medicare's enrollment period ends May 15.

Others, including Merck & Co. and Bristol-Myers Squibb Co., say they will still help seniors, but only the ones who don't enroll in Medicare's drug program.

Industry officials argue that their hands are tied. The inspector general's office of the Health and Human Services Department has told them that companies risk violating the federal anti-kickback law if they give free prescriptions to anyone enrolled in a federally subsidized drug plan.

The cutbacks worry senior advocates like Kerry Smoot at the Senior Source in Dallas. She's helped hundreds of older adults apply for free or reduced-priced medications.

"I'm afraid some people will pay much more for their drugs under Medicare than they did through the patient assistance programs," Smoot said. "That's because they'll be charged premiums, deductibles and co-payments. It's frustrating."

She especially fears that seniors with lots of prescriptions will fall into Medicare's "coverage gap." After a beneficiary's total drug costs exceed $2,250 a year, Medicare covers no more until total costs hit $5,100. After that, catastrophic drug coverage takes over and pays 95 percent of all expenses.

Smoot said many of her seniors had run up huge credit-card debts, split pills or done without prescriptions before they applied for the drug companies' help.

The programs came about over the last couple of decades to help lower-income people who couldn't get affordable medications elsewhere, said Johnson of the pharmaceutical group.

"But suddenly, the need isn't as great for seniors," he said. "Now they can choose from dozens of government-subsidized drug plans. We're convinced many will look at Medicare and conclude it's a better deal."

Medicare's drug plans will cover more medications, and they won't have to worry about the patient assistance programs' complicated application process, Johnson said.

When Eli Lilly announced that it would stop filling prescriptions for 200,000 seniors, it encouraged them to sign up for a Medicare drug plan and set up a hotline to help them enroll, said company spokesman Ed Sagebiel.

Tricia Neuman, vice president of the Kaiser Family Foundation in Washington, agrees that switching to a Medicare plan may be better for the poorest seniors, since they qualify for extra help with out-of-pocket Medicare drug costs.

Individuals with annual incomes below $14,355 can get a break on premiums, deductibles and co-payments, so they'll probably pay less than they did through the drug company programs, she said.

But seniors with incomes above that don't qualify for help. They were poor enough to get accepted in the drug companies' programs but now face deductibles, premiums and copays.

Not all seniors are being shut out of the assistance programs. Some can continue to receive their pharmaceutical assistance as long as they don't enroll in a Medicare drug plan.

"Why must it be an either/or proposition - choose us or Medicare?" she said. "What about the person who's been getting help through several assistance programs? If he loses only some of his free prescriptions, will he have to drop them all to get Medicare?"

Laura Bradbard, a spokeswoman for Health and Human Services Department's inspector general's office, said there's a way around the dilemma if drug makers are sincere about helping older adults on lower incomes.

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