Spending on retail prescription medicines has consistently accounted for just 10 percent of health care spending, even though biopharmaceutical companies have brought more than 500 medicines to U.S. patients in the past 15 years. That's because the marketplace for prescription medicines is unlike any other part of the U.S. health care system. High utilization rates of generics, competition among brand-name medicines and aggressive tactics by insurers to negotiate prices all help to keep costs under control.
Despite this, insurers are increasingly forcing patients to pay an ever-growing share of their medicine costs, sometimes 30 percent, 40 percent or even 50 percent. That’s far more than they require for more expensive hospitalizations and medical procedures.
The impact this high-cost sharing is having on patients was made clear in the latest Kaiser Family Foundation (KFF) Health Tracking Poll where 76 percent of respondents said their top health care priority is making sure medicines are affordable for those who need them. This was the number one overall priority for those surveyed.
The survey also found almost half (47 percent) of people can’t pay $500 for an unexpected medical bill or would have to take on debt to pay the bill. That percentage rises to 63 percent for an unexpected $1,500 medical bill.
This data makes it clear patients may have trouble paying the deductible for many of the plans in the health insurance exchanges. Deductibles for the silver plans, the most popular plans in the exchanges, average about $3,000, and more than half of silver plans require patients to reach their full deductible before medicines are covered.
As more people gain access to health coverage it’s important to consider whether or not they can access the care they need. Too many Americans are facing the challenge of health coverage that pays for a trip to the hospital but not the medicine needed to prevent that visit.