Uninsured Columbia consumers pay an average of 67 percent more for 10 commonly prescribed medications than the best available market prices, according to a survey released Tuesday by the U.S. Public Interest Research Group.

“The people who can least afford it are always the ones being charged the most. ... They have no leverage at all,” said Sue Berkowitz, director of the S.C. Appleseed Legal Justice Center.

The survey highlights a costly, complex problem South Carolina and other states are struggling with: How to keep down health care costs by making prescription drugs more affordable.

Jill Johnson, of Public Interest Research Group’s Atlanta office, praised South Carolina and Gov. Mark Sanford for creating a preferred drug list meant to cut costs of the state’s Medicaid program.

The state also has expanded the number of residents eligible for SilverCard, which gives prescription drug coverage to the uninsured elderly.

But neither state nor federal legislators are doing enough, Johnson said.

“Although they’re moving the issue forward, we don’t think they’re really doing much to tackle the issue of the high cost of prescription drugs,” she said.

South Carolina is working on the problem, and the Department of Insurance hopes to make recommendations to the Legislature and the governor in about two months.

About 14 percent of state residents are uninsured, according to the census.

When people put off getting the care or the medicine they need, it costs everyone in the long run, Berkowitz said.

“Many times, with no insurance and with drugs so high, people just go without,” she said. “Then they get sicker and sicker, and eventually they end up needing public assistance.”

That could have happened to Dianne McLeod, of Lee County. But she didn’t live long enough.

McLeod died last spring at 54, unemployed and uninsured, said her sister, Marilyn Collins of Sumter. McLeod had cared full time for their handicapped brother since their parents’ death several years ago.

McLeod often did without medication she needed because it was too expensive, her sister said.

“I would say, ‘Diane, you really need to get this checked out.’ She would say, ‘Well, I don’t have the money.’”

Collins helped when she could. When her sister had pneumonia, Collins came up with $400 for prescription drugs, doctor visit and X-ray. But abdominal pains McLeod tried to ignore caught up with her, and 14 days after she was diagnosed with colon cancer, she died.

“It’s just a shame that people can’t be taken care of adequately because they don’t have money,” Collins said.

A matter of

buying power

Lacking the buying power of hospitals, large employers or HMOs, individuals with no insurance have no one lobbying for price breaks.

But whose fault is it — the drug companies, the government, or those with insurance who use prescription drugs more than they need to?

“I think probably, as in most cases, the truth is someplace in the middle,” said Gene Reeder, a professor in USC’s College of Pharmacy.

If more uninsured people got the special deals negotiated for veterans, say, or for big companies, people with insurance could see higher co-payments at the drugstore.

“The more people we insure or provide low prices for, the rest of us are going to pick up the tab,” said Reeder, an expert on the economics of prescription drug use.

To see how much more uninsured people were charged for medication, the Public Interest Research Group did on-site and phone surveys in 18 states and the District of Columbia.

They got prices for one-month supplies of 10 frequently prescribed drugs, including household names such as Prilosec, Plavix, Zocor and Celebrex.

They compared these prices with federal supply prices — negotiated by pharmaceutical companies with the government.

Columbia prices, on average, were 67 percent higher than the federal supply prices.

The price difference was greatest in the Northeast (almost 76 percent) and Mid-Atlantic region (80 percent). Highest prices were in Baltimore, with costs 87.4 percent above the federal supply price.

Reeder said it is no surprise the average uninsured person can’t swing the same deal at the drugstore as do federal agencies.

“They represent a lot of lives,” he said. Thus federal agencies such as veterans’ hospitals have even more buying power than the biggest company or the most influential HMO. (For example, Columbia’s Dorn VA Medical Center cares for close to 38,000 patients each year.)

The public interest group would like to see state and private cooperatives in which agencies and employers band together to have more bargaining power.

Since many of the uninsured have jobs, this type of co-op arrangement could help smaller employers provide health benefits. Also, Johnson said, a state’s buying pool could include some private business associations, HMOs and even individuals.

Yet covering costs of medication entails tough choices, Reeder said.

States could form European-style pricing boards to force prices down, but costs probably would be shifted to private consumers, he said.

There is also the fear that if drug companies profits are cut drastically, they would not put as much money into research to develop new drugs.

Reach Lamb at (803) 771-8454 or llamb@thestate.com.