The Cost of Medication Copays
Universal healthcare. It is quite odd how the rest of the world has been able to implement access to healthcare for all, yet the concept remains an enigma in the United States. Year after year, the data demonstrates that the U.S. far exceeds the health expenditure per capita of other countries, yet the issue remains unaddressed. In pharmacy, we witness firsthand the barriers to healthcare access, particularly with regards to drug coverage. As the daughter of Pfizer employees, accessing medications has never been an issue for me. In fact, I’m the annoying patient who requests Zithromax Z-packs instead of generic azithromycin because I have no copay. However, working in community pharmacy has opened my eyes to the reality that the majority of people do not have adequate drug coverage and regularly encounter unaffordable copays. I frequently encounter patients who come to pick up medications and realize that they cannot afford all of them. It breaks my heart watching them go through their medications and choosing which to take home and which to have returned to stock. Despite the increasing coverage in the media that drug prices have received, very little has been done to improve drug coverage in this country.
According to a 2019 report by the House Committee on Ways and Means, U.S. drug prices were found to be nearly four times higher than the average prices in countries of similar status. The report highlighted issues with the lack of regulation in drug pricing in the U.S., arriving at the conclusion that the U.S. could save $49 billion annually on Medicare Part D alone if the U.S. were to follow the average drug prices for other countries. Variability in prescription coverage just compounds the problems created by inadequate regulation in drug pricing and ultimately ends up causing the patients who need medications the most to suffer.
Furthermore, critical maintenance medications such as insulins, DOACs, and ARNIs are infamous for having copays that are hundreds of dollars. Yet patients on these medications are forced to pay the hefty costs for them month after month because their only other option leads to devastating consequences to their health. Despite the clear evidence and guidelines that emphasize the need for these medications, insurances are unwilling to cover the costs of these essential medications. As pharmacists, we have the responsibility of addressing barriers to adherence, yet cost remains one of the top barriers and there is very little that we can do to overcome it. Medicare and many employer drug insurance plans have opted for high deductible health plans. But what good are those plans when patients cannot afford to reach that deductible? How are patients able to treat manage their chronic disease states when they cannot access the medications necessary to do so? Ultimately, patients should not feel the need to prioritize between their health conditions nor bear the bear the burden of cost in being able to access medications.
According to a 2019 report by the House Committee on Ways and Means, U.S. drug prices were found to be nearly four times higher than the average prices in countries of similar status. The report highlighted issues with the lack of regulation in drug pricing in the U.S., arriving at the conclusion that the U.S. could save $49 billion annually on Medicare Part D alone if the U.S. were to follow the average drug prices for other countries. Variability in prescription coverage just compounds the problems created by inadequate regulation in drug pricing and ultimately ends up causing the patients who need medications the most to suffer.
Furthermore, critical maintenance medications such as insulins, DOACs, and ARNIs are infamous for having copays that are hundreds of dollars. Yet patients on these medications are forced to pay the hefty costs for them month after month because their only other option leads to devastating consequences to their health. Despite the clear evidence and guidelines that emphasize the need for these medications, insurances are unwilling to cover the costs of these essential medications. As pharmacists, we have the responsibility of addressing barriers to adherence, yet cost remains one of the top barriers and there is very little that we can do to overcome it. Medicare and many employer drug insurance plans have opted for high deductible health plans. But what good are those plans when patients cannot afford to reach that deductible? How are patients able to treat manage their chronic disease states when they cannot access the medications necessary to do so? Ultimately, patients should not feel the need to prioritize between their health conditions nor bear the bear the burden of cost in being able to access medications.
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