Costs Block Prescription Access for Millions: Study


December 3, 2021 – As Senate Democrats debate the Build Back Better Act, which includes measures that would reduce prescription drug costs for consumers, a new Urban Institute study finds that $ 12.8 million adults delayed or did not obtain necessary prescription drugs because of cost.

People who deferred or did without these prescription drugs included 2.3 million elderly Medicare beneficiaries, 3.8 million non-elderly adults with private insurance, 1.1 million Medicaid beneficiaries and 4 , 1 million adults who were uninsured at any time during the previous year.

Nationally representative data is from 2018-2019, before the start of the COVID-19 pandemic. Researchers at the Urban Institute used information from the Medical Expenditure Panel Survey conducted by the Agency for Healthcare Research and Quality.

According to the study, about 1 in 10 adults uninsured all year (9.5%) or part of the year (11.6%) had unmet prescription drug needs, compared with 4.9 % of Medicare enrollments, 3% of privately insured unattended adults, and 5.6% of non-elderly adults on Medicaid.

Among Medicare beneficiaries and privately insured adults, unmet prescription drug needs were most common among women, those with low incomes, and those with multiple chronic conditions. More than 6 million adults with Medicare or private insurance delayed getting or deprived of needed drugs because of the cost.

Almost all Medicare members and 82% of unmet privately insured adults with unmet drug needs had one or more chronic conditions such as high blood pressure, high cholesterol, stroke, diabetes, arthritis and respiratory disease. The study points out that when people are diagnosed with such conditions and cannot get the drugs they need, they are likely to have poor results.

A larger portion of Medicare members with multiple chronic conditions (5.6%) had difficulty paying for their prescription drugs than those with no condition (1.5%) or one condition (1.7%), according to the study. Among non-elderly adults with private insurance, 5.4% with multiple conditions reported not being able to afford their medications, compared with 1.5% who had no conditions and 2.3% who had. affection.

Drug costs and ability to pay

Overall, prescription drugs accounted for up to 14% of national health spending during the study period, according to the study. In contrast, drugs accounted for nearly 22% of personal spending for Medicare members and about 17% of spending for privately insured.

Like spending on other types of health care, direct prescription drug spending is highly concentrated among certain groups of people. Among privately insured non-elderly adults, 5.3% spent more than 1% of their family income on prescription drugs; 6.1% reported personal expenses greater than $ 500; 2.3%, over $ 1,000; and 0.8%, over $ 2,000.

Direct spending on prescription drugs exceeded 1% of household income for 25.4% of Medicare beneficiaries, and 3.4% spent more than 10% of household income on drugs. Personal drug expenses exceeded $ 500 for 21.5% of this cohort; 8.9% of Medicare members spent more than $ 1,000; and 2.7%, over $ 2,000.

Over 7% of Medicare beneficiaries with unmet prescription drug needs reported spending more than $ 2,000. Only 2.3% of privately insured unattended adults with unmet drug needs reported the same.

The Build Back Better Act would have a major impact

The 1.3 million Medicare beneficiaries who spent the most on prescription drugs would be directly affected by the Build Back Better Act, which caps prescription drug spending for Medicare members at $ 2,000.

Among other things, according to the report, the law:

  • Allow Medicare to negotiate the prices of certain expensive drugs covered by Parts B and D
  • Limit beneficiary cost-sharing of insulin to $ 35 per month for people on health and commercial plans.
  • Decrease in coinsurance in the initial phase of Part D from 25% to 23%
  • Establish mandatory discounts for Medicare-covered drugs with prices rising faster than inflation
  • Increase incentives for Party D to negotiate lower prices with manufacturers

Additionally, passing the Build Back Better Act would make health insurance affordable for more uninsured people, including people who live in states that have chosen not to expand Medicaid under the Act. Affordable Care Act, notes the study. Expanding coverage would make it easier for those who are currently uninsured to purchase the prescription drugs they need.

WebMD Health News


Urban Institute: “In the years leading up to the COVID-19 pandemic, nearly 13 million adults delayed or did not need prescription drugs because of the costs. “

© 2021 WebMD, LLC. All rights reserved.

Leave a Reply