A trip to the pharmacy can be expensive, especially for older Americans. Nearly one in four seniors has trouble affording their medications, according to a recent survey from the Kaiser Family Foundation.
A new proposal from the Trump administration will add to these seniors’ woes. The reform, released last month by the Centers for Medicare and Medicaid Services, legitimizes a destructive tactic that some insurers use to extract more money than they should from patients. If implemented, the proposal would make it even more difficult for people to afford their medications.
High out-of-pocket drug costs have been a major challenge for our health system for some time. But, in recent years, the burden borne by older Americans has gotten worse.
Roughly 7.5 million seniors can’t pay for some of their prescriptions. And in 80 percent of cases, the copays that seniors struggle with are for drugs that treat “a somewhat or very serious health condition,” according to a recent report by Gallup and West Health, a nonprofit.
Too often, to cope with high out-of-pocket costs, seniors deviate from their prescribed treatment regimen by skipping doses, cutting pills in half, or failing to fill prescriptions altogether. Indeed, as many as half of those living with a chronic disease have failed to take their medicines as prescribed, often because of cost.
The consequences of this medication “non-adherence” can be severe — and sometimes life-threatening. Non-adherence leads to more than 100,000 deaths a year and is behind 10 percent of hospitalizations.
Fortunately, support programs to help seniors afford their medications abound — and are proliferating. Many drug companies offer “co-pay assistance programs” to help seniors reduce their out-of-pocket medication expenses.
Normally, the value of any prescription-drug coupon counts toward a patient’s deductible. In this way, coupons reduce how much of her own money a patient must spend before she hits her deductible and her insurer starts picking up the tab.
For patients who depend on one or more brand-name medicines, such copay-assistance coupons can be life-changing. The value of these discounts totaled $13 billion in 2018 — up from $6 billion in 2014. One in five privately insured patients that takes a brand-name drug uses coupons to defray some of their costs.
Moreover, several studies have shown that manufacturer coupons raise adherence rates for a number of different medications.
Increasingly, though, insurers are ignoring copay assistance coupons when calculating a patient’s out-of-pocket maximum. The motivation here is to shift a greater share of drug costs onto patients — even if it means endangering the health of those already struggling to pay for their medicines.
It’s no surprise, then, that several states have passed laws requiring health plans to count manufacturer coupons toward a patient’s deductible. Yet instead of strengthening those efforts, the Trump administration appears poised to give insurers its blessing to ignore copay assistance coupons.
The reform would be unacceptable coming from any administration, but especially one that has promised to make lowering drug costs a priority.
The proposal puts the financial interests of insurance companies before the lives of actual patients. And it betrays America’s seniors.
