DPH plans to charge poor patients for medicines at rates they know patients cannot afford, in order to decrease patients' use of medicines, save costs, and drive patients away.

DPH plans to charge 3,850 of its patients who are above the Federal Poverty Line $5 for each generic medicine, and $10 for each brand-name medicine. These patients' income is $775 per month for a single person, and they comprise about 11% of DPH's pharmacy-eligible population. Since prescriptions are for 30-day supplies, these charges would recur every month. Insulin, antibiotics, antipsychotics, and drugs CHN gets from Patient Assistant Programs are exempted.

Pharmacy workers have already being told not to allow any exceptions, and that no alternative procedures are being set up for patients who do not have the money. If patients do not have the money, they simply will not get their medicines.

Many sick patients, often poor from their medical expenses, use six or seven prescription medicines at once. There is no way they can afford these co-pays. These policies will kill patients; there is no getting around this.

DPH is not charging the co-payments simply to raise money. They expect the sum of the co-payments to be only $135,800. DPH also calculates that that a significant portion of its above-poverty-level patients will not be able to afford all their co-payments, and that mandatory co-pays would force down medicine usage of this group by 13%, saving $110,000. For the average patient, this would be equivalent to having a day's medicine taken away every week!

For DPH to base its financial strategy on the expectation that it can exclude a significant fraction of its patient base by pricing them out of the market is totally reprehensible and contrary to any kind of principles of public health. When combined with DPH's plans to dismantle the administrative structure and care-giving staff of the Primary Care Clinics, a reasonable person could question DPH's long-term commitment to delivering health care at all.

DPH knows that last time it charged drug co-pays there were near-riots in the pharmacy, and they had to post two guards for month. DPH also knows that two emergency room visits would wipe out the $233,000 saved. Why then, is DPH making the charges?

The only reasonable answer is that DPH's long-term financial strategy is to drastically reduce its costs by greatly reducing the number of patients, and that the co-pay plan is being instituted to drive patients away.

The consequences of refusing patients medicines without co-payments

A letter from Kevin Grumbach on the effect of mandatory pharmacy co-payments

SF General and other public hospitals have been repeatedly overcharged for drugs in a program supposedly providing discounted drugs for safety-net providers.

While planning to cut vital medicines to San Francisco's most vulnerable patients, DPH pharmacy operation have wasted millions of dollars buying drugs at high prices and contracting with for-profit Pharmacy Benefit Managers to do work that Pharmacy Management should have done themselves. 

Read how angry patients and workers sat in on the Board of Directers of Atlanta's Grady Hospital after it started charging copays to its poor and working population.

In the Fall of 1999, hundreds of patients were forced to stand lines for many hours at the Main Pharmacy of San Francisco General Hospital.    Hospital administrators wanted to drive Medi-Cal patients away, and had closed an auxiliary pharmacy with the express purpose of  creating long lines in the Main Pharmacy.  Hundreds of angry patients and health workers flooded Health Commission meetings to prevent Administration from closing the Main Pharmacy also.