Why Prescription Drug Affordability Matters

It’s pretty safe to say that if I had taken better care of myself in my 30s, 40s and 50s, I wouldn’t be on four regular prescriptions medications at age 61. It’s seven at the moment if you add three short-term  prescription meds for a bad case of bronchitis as I write this. 

On the plus side, at the moment, I can afford my drugs, which I pray will help me get into my 70s, 80s and maybe even 90s. I’ve been steadily employed since age 23 and have always had health insurance coverage with pretty decent prescription drug benefits.  

I’m lucky. But millions of other adults aren’t.

A new report from the Urban Institute says that nearly 13 million adults didn’t get their prescriptions filled right away or at all in both 2018 and 2019—the last two years before the COVID-19 pandemic—because of the cost. You can download the 19-page report here. 

Researchers from the Urban Institute came up with that figure by analyzing 2018 and 2019 data from the Medical Expenditure Panel Survey, which the Agency for Healthcare Research and Quality administers each year. The researchers studied three primary sets of adults—those age 65 or older enrolled in Medicare; those age 19 to 64 with private health insurance for a full year; and those age 19 to 64 uninsured for all or part of a full year—who said they delayed or skipped filling one or more prescriptions in the previous 12 months because of the out-of-pocket cost.  

Here’s how the numbers broke down:

• 4.1 million, or 32 percent, were nonelderly adults uninsured for all or part of a full year
• 3.8 million, or 30 percent, were nonelderly adults with private health insurance for a full year
• 2.3 million, or 18 percent, were Medicare-only enrollees with drug coverage for a full year
• The balance—2.5 million, or 20 percent—were nonelderly adults with Medicaid coverage or coverage from another source and dual eligible Medicare beneficiaries with Medicaid coverage

What’s interesting about what the researchers found is the fact that nearly half—48 percent—of those who said they delayed or skipped filling a prescription because of the cost had health insurance for a full year either through Medicare or through a commercial health plan. In-other-words, they couldn’t afford their out-of-pocket deductibles, coinsurance and copayments for their medications even with insurance.

And it didn’t take much in terms of dollars for them to delay or skip a prescription. For 44 percent of the Medicare beneficiaries, it was as little as $500 a year. Same for 21 percent of the nonelderly adults.

“Though most adults with Medicare or private coverage had modest out-of-pocket costs for prescription drugs, some experienced high spending burdens relative to their incomes, which could further exacerbate unmet needs for other types of care,” the researchers said.

And for what medical conditions did these folks delay or skip their meds?

For Medicare beneficiaries, the top five conditions were:

• Joint pain, including arthritis
• High blood pressure
• High cholesterol
• Heart disease
• Diabetes

For the nonelderly, they were:

• Joint pain, including arthritis
• High blood pressure
• High cholesterol
• Asthma
• Diabetes

Undoubtedly and unfortunately, a lot of these people will wind up going to urgent care or the hospital emergency room when their chronic conditions escalate into acute problems. All because they couldn’t afford to fill their prescriptions. 

I’m no actuary, but wouldn’t it be fiscally smarter to design benefits plans that make prescription drugs as cheap as possible for patients and incentivize medication adherence so you, as a health plan or payer,   avoid writing big checks to hospitals and medical specialists later? Makes sense to me.  That’s a market-based solution that doesn’t require any government intervention. 

To learn more about this topic, please read “Maybe It’s the Patients, Not the Prices. Is that Stupid?” on 4sighthealth.com

Thanks for reading.