Demand for free medicines in the US has increased sharply following the 2008 economic crisis, highlighting continued difficulties by Americans in gaining access to medical care.

Millions have lost their medical benefits along with their jobs in the downturn, underscoring the challenge for President Barack Obama in overhauling healthcare after signing reforms into law last month. Organisations helping people find free drugs have reported increases of up to 50 per cent in requests in recent months, while pharmaceutical companies say they have expanded donations through “patient assistance programmes” by typically 15 to 25 per cent.

Rich Sagall, who created NeedyMeds.org, a phone and web-based clearing house near Boston helping patients find free medicines, says he is receiving 14,000 inquiries a day, up from 10,000 in late 2008. “We’re exceedingly busy. I’m upset that this many people need access. There’s definitely more need and more queries.” US pharmaceutical companies provide some medicines free to many poorer Americans through “patient assistance programmes”.

Since launching its Partnership for Prescription Assistance to co-ordinate these programmes in 2005, PhRMA, the pharmaceutical industry trade association, says it has provided 6m patients with $16bn (€11.8bn, £10.5bn) of drugs valued at wholesale prices, rising to 30m prescriptions a year. It says it spends many millions of dollars a year marketing and operating the partnership.

Yet these programmes still cover only a fraction of those people in need of medicines who struggle to meet the costs.

Doctors say rising demand is compounded by restrictions and variations in eligibility for free medicines that healthcare reform will do little to tackle. Some criticise limited transparency and co-ordination between the different programmes, which help defuse criticism levelled at pharmaceutical companies for high drug prices.

“A third of our in-patients say they have problems taking their medications because of cost,” says Niteesh Choudhry, a doctor at Brigham and Women’s Hospital in Boston. “They don’t fill their prescriptions, reduce their dose or split pills. It’s a very common phenomenon.”

While Dr Sagall praises the existence of the programmes, he says each company sets different criteria for income levels, which are often discretionary and not made public. Some require copies of tax returns or a “green card” work permit, intimidating many and excluding illegal immigrants.

Patients requiring multiple drugs must also typically apply separately to each programme, creating a burdensome process.

“It’s a patchwork, with programmes totally at the discretion of the pharmaceutical companies,” says Janet Walton from RxAssist, another clearing house that has seen demand rise by a quarter over the past year. “It’s not a coherent or sustainable system.”

She says Merck will give free drugs to patients earning up to four times the federal poverty level, while Takeda only allows those at three times the threshold. Bristol-Myers Squibb has restrictive criteria for its blood thinner Plavix, while some pain and attention deficit disorder drugs are not available at all.

Even as people have lost their jobs or had their benefits reduced, the average price of patented medicines sold in pharmacies has increased significantly. Drug companies stress that their own revenues have risen more modestly after accounting for discounts negotiated by health insurers and hospitals.

Ironically, the only patients who pay the full retail pharmacy prices are those who can least afford to: those with no coverage.

But while some of these Americans will benefit as Mr Obama’s reforms extend insurance cover to the uninsured, many demands to patient assistance programmes come from the under-insured, whose cover is capped or includes “co-payments” that they struggle to meet.

“There are definitely gaps in the system,” says Denise Sitarik, who runs Johnson & Johnson’s patient assistance programme. “The under-insured are probably our biggest challenge.”

Ken Johnson, senior vice-president at PhRMA, says that his members can only provide a partial solution to healthcare in the US. “You are not going to stay in business long if you give away all your product,” he says. “This is not a statutory requirement placed on us. Our companies do it because it’s the right thing to do.”