Nearly 13 million U.S. adults a year skip or delay filling needed prescriptions due to high price tags, new research shows.
This figure includes more than 2.3 million Medicare beneficiaries and 3.8 million privately insured working-age adults who didn’t get needed medications each year in 2018 and 2019 because of cost, according to a nationally representative survey of U.S. households.
“It’s tragic that millions of people don’t take needed prescription drugs because they can’t afford them,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, which funded the study.
“As we recover from COVID-19 and try to create a more equitable society, ensuring that prescription drugs are affordable must be a policy priority,” Hempstead said in a news release from the Urban Institute, which conducted and published the study.
The survey also revealed that 25% of Medicare beneficiaries and 5% of privately insured adults spent more than 1% of their family income on their individual out-of-pocket prescription drug costs.
More than 3% of Medicare beneficiaries and nearly 7% of beneficiaries with unmet medication needs spent more than 10% of their family income on prescription drugs.
About 1 in 10 adults who were uninsured all or part of the year had unmet prescription drug needs, compared with 4.9% of Medicare beneficiaries, 3% of privately insured adults, and 5.6% of non-elderly adults with Medicaid.
Unmet prescription needs were highest among women, people with low incomes and those with multiple chronic health conditions, the researchers said.
“Policies to reduce drug prices, limit out-of-pocket costs, and expand health insurance coverage could help many people get the prescription drugs they’re currently unable to pay for,” said lead author Michael Karpman, a senior research associate at the Urban Institute.
Medicare For All” gets tossed around a lot by advocates of universal health coverage, but a new study finds that today’s Medicare is far from free for seniors and people with disabilities.
Moreover, effective repeal of the Affordable Care Act’s individual mandate through a provision in the 2017 Tax Reconciliation Act that reduces the penalty for not having insurance to zero in 2019 will have the effect of reducing the number of insured. This will have an effect on health insurance markets, likely reducing the number of younger and healthier people that help give balance to health insurance risk pools and that help keep overall costs down. And without the financial protection afforded by health insurance, those who are uninsured may face rising rates of medical bankruptcy, to say nothing for the loss of access to sorely needed medical care.
Learning From Thailand
To be sure, the Thai and American contexts are very, very different. While health spending stands at around 4 percent of GDP in Thailand, in America nearly 20 percent, or one-fifth, of the country’s total economic output is spent on health. Yet, in some ways, that makes Thailand’s achievement all the more remarkable. And while no program is perfect, Thailand’s reform is one of the reasons that health costs in Thailand have remained so low, despite such a dramatic increase in coverage.
Reformers also drew on other innovative policy instruments to keep costs down, including the Government Pharmaceutical Organization that produces generic medication for the universal coverage program and the use of compulsory licenses, which allow governments to produce or import generic versions of patented medication under WTO law.
The United States, by contrast, seems to be moving in the opposite direction, both in terms of insurance coverage and health outcomes. Although recent Republican efforts to repeal the Affordable Care Act were narrowly defeated, lawsuits that aim to terminate popular pre-existing conditions protections continue. In addition, the Trump administration has sought to weaken the reform in other ways: including by cutting the open enrollment periods, which ends Dec. 15 and lasts 45 days; cutting outreach and advertising for open enrollment; and threatening to suspend risk adjustment payments to private insurers, which help to stabilize the market.
While the U.N. measure was nonbinding and did not commit U.N. member states to adopt universal health care, many global health experts viewed it as an achievement of extraordinary symbolic importance, as it drew attention to the importance of providing access to quality health care services, medicines and financial protection for all.
“The main takeaway message is that legislation on insurance coverage for supplementary screening seems to have a larger impact on breast cancer stage of diagnosis than notification laws for dense breasts overall,” said study author Chan Shen, associate professor of surgery and public health sciences at Penn State College of Medicine, in Hershey.
There were some differences based on age, race and ethnicity. When compared with older women, younger women aged 40 to 49 were more likely to be diagnosed at earlier stages if they lived in states with insurance coverage laws for dense breasts, the study showed.
Largely due to the Cappellos’ efforts, their home state, Connecticut, was the first state to enact breast density notification and insurance coverage laws.
For the new study, researchers examined how or if breast density notification and insurance coverage laws affected the stage of breast cancer diagnosis in more than 689,000 breast cancer cases.
Just being notified that you have dense breasts didn’t seem to make a difference in stage at diagnosis, but insurance coverage legislation did, the study found. Women in states where coverage of additional screening in dense breasts was mandated had 6% lower odds of their cancer spreading to nearby lymph nodes, the study found.