this story is part We lowered the priceCNET’s coverage of how real people are coping with the high cost of living in the US.
When 27-year-old Savannah Brown switched jobs last December, she had more to worry about than meeting co-workers and adjusting to an unfamiliar schedule. Her new job meant another insurance policy, which meant jumping hoops to get her life-saving prescription drug approved.
Brandon Douglas/CNET
With insurance that costs about $5,100 a year, I pay an extra $960 a year for medications to treat severe asthma, psoriatic arthritis, and depression. These pharmacy benefits ease her bills: Without insurance, she would be looking at a staggering $200,000 a year.
As basic spending rises, prescription drug prices are soaring, eating up an even larger portion of household income. According to a recent Department of Health and Human Services government report, prescription drug prices have risen an average of 31.6% in the last year alone, with some rising 500%. With prescription drug prices among the highest in the world and people in other countries paying two to three times her price, an American is trying to find a way around the entangled pharmaceutical industry.
Exorbitant prescription drug costs disproportionately hit low-income households, especially the uninsured and underinsured populations (9% and 23% of US adults, respectively). Black, Latino, and Native American people are less likely to have health insurance and face cost-related barriers to treatment, according to the Commonwealth Fund, a nonprofit focused on health policy reform. more likely to face Without insurance, patients are forced to sacrifice medicine for more pressing needs such as housing and food. People who rely on prescription drugs to manage their chronic conditions can often accumulate medical debt.
According to Frederick Isasi, executive director of health advocacy group Families USA, nearly a third of the adult population in the United States, including those with insurance, are unable to get prescriptions because they can’t afford them. This crisis has detrimental consequences. Nearly three of her 10 adults skip doses, cut pills in half, or miss prescriptions, causing long-term health problems. Some die. As many as 8% of her American households buy drugs abroad to buy them at cheaper prices.
But there is a much less risky workaround. Some patients achieve significant cost savings by choosing generic drugs, asking their providers for alternatives, or switching pharmacies. They rely on advocacy groups, sliding scale health centers, or patient assistance plans. We compare, get coupons, and save at the cash register.
When drug costs interfere with patient health
At the age of 3, Brown had his first break-in with a high-priced drug. After she had a life-threatening asthma attack, her doctor said the best treatment was an adults-only prescription. I didn’t want to cover the drugs, but in the end I gave in.
Controlling her asthma quickly became a barrage of nebulizers, inhalers and steroids, all of which weighed on her family budget. Each time her father changed jobs, she had to wait months for his benefits to kick in, and the bureaucratic roadblocks to getting her medicine began again.
With the enactment of the Affordable Care Act of 2010, Brown’s family was no longer denied coverage or charged extra for her pre-existing medical conditions. But years later, after Braun was diagnosed with psoriatic arthritis, she struggled to find the right medication, and in most cases it took months before her insurance was approved. The list of drugs she tested reads like a pharmaceutical brochure: methotrexate, Humera, Solara, Remicade, and Xeljanz. When her asthma worsened, her pulmonologist told her to take Xolair, but her insurance initially said her lung function was too low to justify her use. I refused her saying I needed to let her go.
When Brown turned 26, she was removed from her parents’ insurance plan and lost all drug coverage. For months, she relied on her doctor’s samples to keep her symptoms under control. Lack of access to her specialty medicines and treatments set her back. “I was losing lung function rapidly,” said Brown, noting that he had permanent lung damage from losing control of his asthma. I was constantly worried that I would end up on a ventilator at . “I was pretty scared for my life,” she said.
If the insurance disability interferes with the patient’s health
Julie Whitehead, 52, who has bipolar disorder, is grappling with similar insurance hurdles, taking a toll on her mental health. In 2015, Whitehead’s doctor prescribed her a new mood stabilizer, Abilify, but her insurance company objected. Abilify didn’t have a popular option at the time, which cost her $1,000 a month.
Whitehead couldn’t afford the hefty price tag, so he was prescribed another drug, Geodon, for his bipolar disorder. However, six months after taking it, she committed suicide. “I was in a good place for five years, then I was hospitalized,” Whitehead said.
In 2020, Whitehead’s doctor wanted to change her medication to Latuda, but this required prior approval. Pre-approval requires a lot of time-consuming paperwork and is often billed if the doctor agrees. Whitehead had to wait three months for him to get the green light, during which time he struggled to pay for Latuda out of pocket, which was more than his monthly Social Security disability check. Fortunately, Whitehead’s husband had enough income for her to cover her expenses. However, this process pissed her off. Even though she was trying to “prevent a medical catastrophe,” she was not admitted due to insurance denials.
Whitehead now pays about $200 a month for 11 prescriptions under her husband’s insurance plan. “Not having insurance and having to rely on Medicaid and Medicare Part D is one thing,” she said. “But it’s kind of a bad thing to pay a royal ransom for insurance and still not cover what you need.”
Battle of David vs Goliath
A study conducted by GoodRx Health found that 28% of adults ended up taking prescriptions not covered by their health insurance, and 13% had their prescriptions canceled by their health insurance. In 2016, Americans spent a total of about $66 billion on out-of-pocket retail prescription drugs.
In addition, many pharmaceutical companies have classified drugs to treat chronic diseases such as diabetes, asthma, HIV/AIDS, hepatitis B and C into higher specialties at high out-of-pocket prices. According to the National Academy of Health Policy, people of color are disproportionately affected by these kinds of serious illnesses and conditions, making such drug-tier policies openly discriminatory.
It takes time and effort to contest denials from insurance companies of critical medicines. It also requires a degree of financial literacy and tools that are generally inaccessible to historically disadvantaged groups. Some patients are unwilling to negotiate costs or sue their health care provider or insurance company.
Vulnerable consumers going up against giant pharmaceutical companies is a battle between David and Goliath, according to Isasi. From 2000 to 2018, 35 pharmaceutical companies reported combined revenues of $11.5 trillion. The pharmaceutical industry, with many of its profits at stake, has focused its lobbying efforts on keeping drug prices high and reducing competition by gaining monopoly power through patents.
Pharmaceutical companies argue that high drug prices are needed to fund R&D, but a recent study conducted by an international team of researchers found a link between pricing policy and R&D investment. was not seen. Pharmaceutical companies set the price regardless of how much it costs to manufacture the drug. “Usually it’s half a penny or a cent to actually manufacture the drug,” Isasi said. “Why can drug companies charge anything they can get away with?”
Alternatives to Obtaining Affordable Drugs
The debate over prescription drug prices has been a central topic in congressional hearings and among legislators for decades.recently passed Inflation control law Medicare has a very limited provision that allows it to negotiate prices with drug companies annually for 10 high-priced drugs beginning in 2026. Also, out-of-pocket prescription drug costs for patients on a Medicare Part D drug plan are limited to $2,000 through 2025.
Many organizations are dedicated to pushing for common sense reform and achieving policy changes to bring down the price of prescription drugs. But until there are groundbreaking reforms in the global pharmaceutical industry, there are some government-based solutions that help the underserved people get life-saving drugs. offers a sliding scale for certain drugs, and the federal 340B program allows certain hospitals and clinics to purchase discounted outpatient prescription drugs for low-income, uninsured patients. I can.
The next step, Isasi said, is to check if patients are eligible for Medicaid through the website. Although eligible income levels are very low, the expansion of Medicaid in 39 states has enabled many economically vulnerable households to cover the cost of prescription drugs. Medicare patients 65 and older can also apply for the Extra Help federal program to receive medicines at heavily discounted rates based on their income.
Patients can also look online for coupons, rebates, or price comparisons. GoodRx offers discount coupons on all FDA-approved drugs, both brand name and generic, regardless of insurance status. According to co-founder Doug Hirsch, if there aren’t any of his GoodRx coupons available, the site will offer coupons from manufacturers to lower prices or display options for similar medicines that are more affordable. . A patient can immediately present his GoodRx coupon to a pharmacy, and the price will more than half of the time be less than the insurance co-pay, Hirsch said.
of cost plus drug companyLaunched by billionaire Mark Cuban, is a new online pharmacy that significantly reduces the prices of generic prescription drugs.A recent study in the Annals of Internal Medicine, co-authored by Dr. Hussein Lalani of Harvard Medical School, found that Medicare could have saved the day. $3.6 billion in 2020 Suppose you purchased 77 prescription drugs through Mark Cuban’s company. Uninsured and underinsured patients will benefit most from using Cost Plus, Lalani said. However, Cost Plus generics arrive in the mail, so patients need to look elsewhere if they need brand-name or clinician-administered medicines, or if they need generics quickly.
read more: How to Get Cheaper Prescription Drugs with Cost Plus Drugs
And NeedyMeds.org, an organization founded by Dr. Richard J. Sagal in 1997, brings together approximately 40,000 patient assistance programs for people who can’t afford medicines and medical bills. This is a free, non-relevant information outlet and visitors to the site are anonymous. Sagall said it gets up to 15,000 daily users looking for low-cost clinics, savings on prescription drugs, rebates his program, and more. The toll-free hotline receives up to 6,000 calls each month from patients seeking resources.
Sagall, a former family doctor, said the website helps more people than his previous private practice. “Our ultimate goal is to close the business because we no longer need it,” says Sagall. “I don’t think that will happen in the near future.”
