According to the report, more than 2.3 million elderly Medicare beneficiaries and 3.8 million privately insured working-age adults reported skipping needed treatments because of costs. (Image: Shutterstock)
Even before the economic upheaval created by the COVID-19 pandemic, 13 million Americans delayed or skipped getting prescription drugs due to affordability issues, according to a new study from the Urban Institute and the Robert Wood Johnson Foundation (RWJF).
The report, based on a national survey of U.S. households, outlined the range of obstacles that Americans face in affording needed medications.
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"Though prescription medicines often provide critical and even lifesaving treatment, rising drug prices place pressure on health insurance premiums and government budgets and can lead to high out-of-pocket cost burdens for patients, including those with health insurance coverage," the study said. "People may also delay or forgo needed medications in response to high drug costs, worsening their acute and chronic health conditions and sometimes necessitating more expensive treatments."
According to the report, more than 2.3 million elderly Medicare beneficiaries and 3.8 million privately insured working-age adults reported skipping needed treatments because of costs in both 2018 and 2019.
The report comes at a time when Congress is considering several legislative initiatives to address high drug costs, including President Joe Biden's Build Back Better Act. These proposals take a range of approaches, including capping out-of-pocket costs of prescription drugs for Medicare recipients, allowing the government to negotiate lower prices with manufacturers, and increasing rebates to consumers.
Out-of-pocket costs a burden for many
The researchers found that more than one-quarter of adults with Medicare (25.4%) and 5.3% of privately insured adults spent more than 1% of their family income on their individual out-of-pocket prescription drug costs. Some Medicare enrollees paid much higher costs—more than 3% of Medicare beneficiaries spent more than 10% of their family income on prescription drugs.
Not surprisingly, affordability was a bigger problem for uninsured people. Nearly one in ten (9.5%) of adults who lacked insurance coverage for an entire year reported unmet prescription drug needs. Those reporting that they lacked insurance for part of the year reported higher unmet needs, at 11.6%. This compares with about 5% of Medicare beneficiaries and 3% of privately insured adults who reported unmet prescription drug needs.
The report also underscored the impact on vulnerable populations: unmet prescription drug needs were most common among women, people with low incomes, and people with multiple chronic health conditions.
A big part of the health care cost puzzle
The report noted that prescription drug costs are often cited as contributing to the problem of high out-of-pocket health care costs for consumers. "Though prescription drugs account for up to 14 percent of national health they represent nearly 22 percent of out-of-pocket costs for the Medicare beneficiaries in our sample and nearly 17 percent of such costs for privately insured nonelderly adults," the report said.
The study concluded by noting the different legislative proposals to make prescription drugs more affordable could help a wide range of Americans, with benefits for both public program enrollees and those on private health plans.
"It's tragic that millions of people don't take needed prescription drugs because they can't afford them," said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. "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."
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