Best-seller in state drug card program is not one of top 10

1/25/2008 © Florida Health News
By Carol Gentry and Christine Jordan
TALLAHASSEE -- The administration of Gov. Charlie Crist says safeguards in its new prescription drug-card program should prevent diversion of the controlled drug Soma -- the No. 1 seller in the state-sponsored discount program -- to the black market. Spokesman Thomas Philpot said before any prescription is filled, it must be written by a doctor and verified by a pharmacist “It’s a commonly prescribed drug,” Philpot said. However, the drug is not one of the top 10 in sales of prescription drugs nationally, according to IMS Health, which compiles data on the pharmaceutical industry. 
Florida Health News reported Thursday that the state program's top-selling  prescription drug appears on the Drug Enforcement Administration's list of drugs that are frequently abused or sold on the street. Attempts to reach the director of Florida's Office of Drug Control, Bill Janes, were unsuccessful Thursday.
Crist held a news conference on Wednesday to announce that more than 20,000 uninsured and elderly Floridians have signed up for prescription-drug discount cards since the state-sponsored program began a month ago. He said the cards have saved users nearly $58,000. 
Information released by his office showed the drug most frequently purchased through the program is carisoprodol, or Soma, “one of the most commonly diverted drugs” from legitimate use to street sales, according to the DEA’s Office of Diversion Control. Abuse of the drug, the DEA Web site says, “has escalated in the last decade.”
By buying the drug through Florida’s state-sponsored program, card holders saved 53 percent on the price of carisoprodol, the governor’s press release said. The state’s web site for prescription drug prices, www.myFloridaRx.com, shows that a month’s supply of 350 mg. tablets, 90 pills, averages $40 to $50 in urban and suburban pharmacies. Thus, card-holders could get 90 Soma pills for a little over $20.
According to the DEA, Soma sells on the street for $1 to $5 a pill. So a one-month supply of 90 pills that costs Florida card-holders a little over $20 could bring anywhere from $90 to $450 if they divert it to the black market.
The legitimate use of Soma is for short-term relief of muscle pain and spasms, according to medical sites. The drug is supposed to be used for only a week or two in combination with rest and physical therapy – a temporary solution to a sore back or neck. Prolonged abuse, according to the DEA, can lead to dependence and withdrawal symptoms when the drug is stopped.
The reason for its popularity on the street, according to the DEA, is that when combined with other drugs, particularly narcotics, Soma can produce euphoria. Addicts are said to like Soma because it adds to the punch of more expensive street drugs, making it possible to get high for less money. That has produced a thriving black market, the DEA says, fueled by “doctor-shopping.” Often it’s hard for doctors to tell the difference between a legitimate patient who has pulled a muscle and a sophisticated doctor-shopper, DEA says.
While the federal government doesn’t classify carisoprodol as a controlled drug, Florida does. State law lists it as a Schedule IV, with a lower potential for abuse than anabolic steroids or codeine, but still requiring strict precautions in prescribing.
Florida Medical Examiners reported that Soma was implicated in more than 300 fatal overdoses in the state in 2005, surpassing deaths from heroin, Dilaudid and other strong addictive painkillers. The number of deaths from carisoprodol jumped 51 percent in two years, they said.
The drug-discount cards are available to any Floridian age 60 and older. Those who are younger must meet income limits – about $30,600 for one person, $62,000 for a family of four.
Of those enrolled in the program, only about 1,700 people have used it so far, the governor’s office said. Philpot said officials expect use of the cards to surge as participants use up their supplies of drugs and go to the pharmacy for refills. Almost 3,800 retail pharmacies are participating.
The program is being administered by Envision Pharmaceutical Services, a pharmacy benefits manager based in Ohio. Envision receives discounts from drug companies for buying in bulk, then passes the discounts on to card holders.
It costs $1.50 to activate the card and $1.50 dispensing fee per prescription, added to the discount price. The price and percentage discount vary depending on the drug. Applications are available at www.FloridaDiscountDrugCard.com or 1-866-341-8894.
Crist’s office reported that just over 6,800 of the discount card holders are 65 or older and 540 of them have used the cards, filling 1,039 prescriptions. Without the cards, the $52,000 they spent would have been one-third more, nearly $69,500.
More than half of the 20,459 Floridians enrolled in the program are younger than 60, the governor’s report said. Ages 45 to 59 use the program the most, it said, and people in that age group filled about 1,200 prescriptions, ¾ of them generics.
The governor said that means the cards are meeting a need among working families who lack health insurance entirely or have no coverage for prescriptions. Florida has one of the highest rates of uninsured, estimated in recent reports at almost one in four persons under age 65.
Crist said he will propose other measures to help the uninsured before the Legislative session gets under way in March.