Price hikes cause drug rationing – turns case

(Rachel Murphy, journalist for Verywell Health and Health.com and CNET, 12/27/2022, “Prescription Drugs Costs Are Making Americans Sicker. Here’s How They’re Coping,” CNET, , DA: 06/29/2024) jj-wh

As basic expenses increase, soaring prescription drug prices are eating up an even larger portion of household income. Over just the last year, prescription drug prices rose at an average rate of 31.6%, with some increasing up to 500%, according to a recent Department of Health and Human Services government report. Americans, who pay the highest prices in the world for prescription drugs -- two to three times more than people in other countries -- are finding any way possible to get around the entangled pharmaceutical industry.

Exorbitant prescription drug costs disproportionately hurt lower-income households, particularly the uninsured and underinsured populations (9% and 23% of US adults, respectively). Black, Latino and Native American people are less likely to have health insurance and more likely to face cost-related barriers to treatment, according to the Commonwealth Fund, a nonprofit focused on health policy reform. Without insurance, patients are forced to sacrifice their medications for more immediate needs, such as housing or food. Those who are reliant on prescription drugs to manage their chronic conditions can often accumulate medical debt.

Almost a third of the US adult population, including those with insurance, can't take their prescriptions because they can't afford it, according to Frederick Isasi, executive director of the health advocacy group Families USA. The crisis has damaging consequences: Nearly three in 10 adults end up skipping doses, cutting pills in half or not filling their prescription, resulting in long-term health complications. Others get desperate -- as many as 8% of American households have purchased medications outside the US to get a lower price.

But there are far less risky workarounds. Some patients score significant cost savings by opting for generic medications, requesting alternative medication from their providers or even switching pharmacies. Others who are financially vulnerable turn to advocacy organizations, sliding-scale health centers or patient assistance plans. And many turn to third-party sites like GoodRx, NeedyMeds.org or, more recently, Mark Cuban's Cost Plus Drug Company to cost-compare medication prices, get coupons and save at the register.

When drug costs stand in the way of patient health

Braun had her first run-in with high-cost medicine when she was 3 years old. After she had a life-threatening asthma attack, her doctors said the best treatment was an adult-only prescription. The insurance company didn't want to cover a drug that wasn't approved for her age group by the Food and Drug Administration, though it eventually gave in.

Controlling her asthma soon became a whirlwind of nebulizers, inhalers and steroids, all of which cut into her family's budget. Every time her father changed jobs, she had to wait months until his benefits kicked in, and the bureaucratic obstacles to get her meds began again.

With the 2010 enactment of the Affordable Care Act, Braun's family could no longer be denied insurance coverage or charged more for her preexisting condition. But a few years later, after Braun was diagnosed with psoriatic arthritis, she struggled with trying to find the right medication, and most of them took months for insurance to authorize. Her list of tested drugs read like a pharmaceutical representative's brochure: Methotrexate, Humera, Solara, Remicade and Xeljanz. When her asthma worsened, her pulmonologist told her to take Xolair, but insurance initially denied her, saying she needed to have less lung function to warrant its use.

When Braun turned 26, she got kicked off her parents' insurance plan and lost coverage for all her medications. For months, she was stuck relying on her doctor's samples to keep her symptoms at bay. Not having access to her specialized drugs and treatment set her back. "I was losing lung function rapidly," Braun said, noting that she now has permanent lung damage from not being able to control her asthma. Braun was constantly worried about ending up on a ventilator in the hospital without insurance coverage. "I was pretty scared for my life," she said.