Many Americans continue to grapple with staggering prescription prices though the promise of lowering prescription drug prices is buried in the to-do pile. On top of the economic crisis, the pandemic has put the country through, unreasonable drug prices have made an even larger dent in senior American’s pockets. With Congress unable to come to an agreement about anything lately, like the second stimulus package, the drug price problem has become yet another unsolved issue for the American people.
Doctors feel responsible for compensating for the lack of effort put in by the government to help lower drug prices. Dr. Barbara McAneny, an oncologist in Albuquerque, New Mexico, and past president of the American Medical Association, said, “If I didn’t do really well at scrounging free drugs and getting copay foundations to work with us, my patients wouldn’t get the drug, which is awful. Patients would just say, ‘I can’t afford it. I’ll just die.’”
Medicare beneficiaries affected most
Those affected the most by high drug prices are seniors with cancer or other serious chronic medical conditions. However, the increase in drug prices has been worse for Medicare beneficiaries. Unlike private health insurance, Part D drug plans do not have a cap on beneficiaries’ coinsurance (5 percent of cost) once they hit $6,550 in drug spending this year (rising from $6,350 in 2020), except for very low-income beneficiaries.
The scariest part of it all is that when patients can not pay their drug prices, they are forced to go without. About half of patients who face a price of $2,000 or more for a cancer drug walk away from the pharmacy without it, according to a 2017 study. Fewer than half of Medicare patients with blood cancer received treatment within 90 days of their diagnosis, according to a 2019 study commissioned by the Leukemia & Lymphoma Society.
Experts advocate for lowering drug prices
Daniel Klein, CEO of the PAN Foundation, which provides drug copay assistance to more than 100,000 people a year, said there are more patients in need than his foundation and other foundations like his to help. He said that without a significant healthcare change, things will continue to worsen.
“If you are a normal consumer, you don’t know much about any of this until you get sick and all of a sudden you find out you can’t afford your medication,” Klein said. Patients are lucky, he added, if their doctor knows how to navigate the charitable assistance maze.
Daniel Sherman, who trains hospital staff members to navigate financial issues for patients, estimates that fewer than 5 percent of U.S. cancer centers have experts on staff to help patients with problems paying for their care. This is detrimental for cancer and other seriously-ill patients to be able to fight their illnesses. Fighting to pay for the medicine should not be part of the battle to survive.
Marilyn Rose was diagnosed with chronic myeloid leukemia three years ago and until recently was paying nothing out-of-pocket for her cancer drug (Sprycel) which costs $176,500/year. The only reason for this is because Bristol Myers Squibb, the manufacturer, paid her insurance deductible and copays for the drug.
“It’s just strange you have to make a decision about your treatment based on your finances rather than what’s the right drug for you,” Rose said. “I always thought that when I get to Medicare age I’ll be able to breathe a sigh of relief. This is a little nuts.”
Sharon Clark, Sharon Clark, who was forced to stop working in 2015 and go on Social Security disability and Medicare after being diagnosed with multiple myeloma (a blood cancer) is only able to get her life-sustaining cancer drug (Pomalyst) which costs more than $18,000 for a 28-day supply only because of the generosity of patient assistance foundations.
Without the foundation grants, mostly financed by the drugmakers, she couldn’t afford the nearly $1,000 a month it would cost her for the medicine since her Medicare Part D drug plan requires her to pay 5 percent of the list price. This means that every year she has to find new grants to cover her expensive cancer drug.
“It’s shameful that people should have to scramble to find funding for medical care,” Clark said. “I count my blessings because other patients have stories that are a lot worse than mine.”
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