With the healthcare landscape seemingly on unstable ground, many consumers are worried about what this could mean for the price of their prescriptions. While we’ve already seen many increases, these high-cost meds could leave many patients who need the drug left out in the cold. Today, prescription drug expenditures are nearly 20% of healthcare costs, and American spending on prescription drugs increased 13.1% in 2014—the largest annual increase since 2003. This uptick was largely driven by an unprecedented 30.9% increase in spending on specialty medications. In 2015, spending rose another 12.2%. Sadly, these numbers are only expected to increase as time goes on. Not only are these high-cost meds putting pressure on patients and healthcare providers, they are putting pressure on doctors as well.
High-cost meds: The cost for patients
A survey done by the National Center for Health Statistics researchers Robin A. Cohen and Maria A. Villarroel found that about 8% of adult Americans don’t take their medicines as prescribed because they can’t afford them. Sadly, this is quite common in today’s healthcare landscape. Many patients simply can’t afford the medications that they so desperately need. And while healthcare providers and the drug manufacturers, themselves, play vital roles in the issue, physicians also play a major role. Doctors are the professionals, who are writing out the prescriptions and making the recommendations, so it’s important to realize how important it is to try to cut down the cost for patients.
Costs for prescription drugs have been rising faster than those for any other health segment, marked by high-profile cases such as the reported 400% increase for Mylan’s EpiPen and 5,000% spike for Turing Pharmaceuticals’ Daraprim. Spikes in price like these are exactly why it’s important for doctors to recommend generic versions of these drugs that essentially provide the same results for a fraction of the price. Healthcare plans have been trying to help the cause by removing the brand name medications from coverage, and consumers are beginning to use websites like GoodRx to find cheaper alternatives to these brand name drugs as well. In many cases, it’s simply too hard for physicians to keep track of the literally thousands of different medications on the market. So, it’s no surprise that many doctors might be prescribing high-cost meds without even knowing there is an alternative generic drug.
The funding issue
So, why are so many physicians still finding it hard to turn away from the high-cost meds? Well, money certainly plays a big role in which drugs take center stage. The majority of drug manufacturing companies put business first at all cost. This is exactly why we see insulin prices increase after new studies show the rise in diabetes, or when a new strain of the flu comes out, we can expect the vaccine to come at a pretty penny. Whether you view it as simply business, or those taking advantage other’s health issue, the fact of the matter is, it’s all about the money. Unfortunately, many of these drug manufacturers will provide payments to doctors who choose to put their drug in the spotlight and prescribe it over others. While this issue has been hotly debated for a while now, a ProPublica analysis has shed light on the issue and found that those who receive payments from the medical industry do indeed prescribe drugs differently on average than their colleagues who don’t receive payments from drug companies. The more money they receive, the more brand-name medications they tend to prescribe.
The healthcare landscape
We can’t forget about the impending new healthcare bill of course. With the GOP moving forward as we speak, these changes could certainly play a role in the price of meds. The Senate Republican’s 142-page Better Care Reconciliation Act (BCRA), if passed into law, will sharply reduce financial aid that currently helps millions of people obtain health coverage, while at the same time offering a tax break to primarily wealthy Americans to the tune of hundreds of billions of dollars. And it would loosen rules in a way that could lead to states allowing insurers to offer less-generous health plans. Many fear this could, in turn, hike up the costs of medications and these pharmaceutical companies will essentially have free reign over pricing points.
If this new healthcare reform does eventually go through, many states will then be put in charge of allocating funding to local hospitals. This new change has many healthcare professionals weary because they’re unsure how exactly state governments will go about allocating these funds. Many fear that budgets could face cuts and funds could be transferred elsewhere, leaving many hospitals struggling to stay afloat. These funds may or may not go to the sources that provide the best care for patients, which would negatively impact providers. Hospitals might try to offset this cost by pushing these more expensive drugs and, therefore, could be costing these patients a lot of money in the long run.
With the number insured expected to grow, many U.S. citizens will be forced to turn towards urgent care facilities or simply skip a hospital visit completely. If they do happen to visit the hospital, many patients will be uninsured and simply not able to pay their hospital expenses. As a result, many hospitals would receive even lower reimbursement than they have in the past, presenting significant financial challenges as they are faced with the likelihood of absorbing additional costs for uncompensated care.
For the select few that can afford health insurance, physicians may be forced to push these high-cost meds onto them simply because they’re the only consumer audience that can afford them.
The healthcare bill has yet to go through, so we really don’t know what we can expect yet. However, it’s important to note just how big of an impact doctor’s play when it comes to high-cost meds. Hopefully, healthcare professionals can continue to fight the battle of high-cost meds despite the impending reform and provide the best possible care for patients at a reasonable cost.