What Happens When the Sick Can’t Afford Their Medication?

By SAM URETSKY

“APOTHECARY: n. — the physician’s accomplice, undertaker’s benefactor, and grave worm’s provider” — Ambrose Bierce

There have been a number of studies of people who can’t afford their drugs, and go without them, or go without some necessity, such as food. Gary and Mary West Foundation, the West Health Institute, and West Health Policy reported, “As many as 18 million Americans can’t afford their prescribed medications, a new nationwide poll finds. That’s 7% of the adult population in the United States. But when it comes to households making less than $24,000 per year, the percentage jumps to 19%.

In 2020, The Journal of the American Board of Family Medicine published a report “Medication adherence and characteristics of patients who spend less on basic needs to afford medications”.

This was done by a survey of 270 low income people in St. Louis asking what steps there were when the price of drugs was unaffordable. Predictably the percentage of people who had serious difficulty increased in people with a greater number of chronic conditions and rated their general health as “fair” or “poor.” The authors note “Previous nationwide studies found that redirecting personal spending from basic needs to health care was more common among female, non-White, younger, and low-income individuals.”

The areas of unmet needs over the past year included food, gas/transport, housing/rent, utilities, and medical expenses. The questions about food asked participants to rate the quality and quantity of food in their household (enough quantity and good quality; enough quantity but lacking in quality; sometimes/often not enough to eat). Prescriptions might go unfilled, or not taken at the full dose.

Obviously this is a problem in treatment, but it also is expensive, since it leads to a greater number of hospitalizations and emotional distress for the patient. While many patients have prescription drug coverage of some sort to protect them from high drug prices, the rules are very complex. But even those with insurance can be exposed to high costs. For example, many insurance plans require patients to pay the full cost of a drug up to a deductible and then contribute co-payments, or coinsurance.

While the Inflation Reduction Act of 2022 allows Medicare to negotiate prices for certain brand-name prescription drugs and, starting in 2025, sets a $2,000 annual out-of-pocket cost limit for patients with Medicare Part D, this policy does not apply to privately insured people in the US.

The emotional effects of being unable to cover the costs of medication have been studied, or normal living expenses can be serious. These can include tension with partners, inability to sleep, and require additional drugs to manage the emotional effects of not being able to afford the prescription in the first place.

Perhaps the best first step is the advice given in the advertisements: “ask your doctor if (dammitol?) is right for you.”

A report from Harvard Medical School tries to find ways to help patients find ways to control drug expenses. They consider seven scenarios which would require at least the most sophisticated computer AI to navigate. The first step is to see if the drug is available as a generic equivalent, and the second step is to see if there are other, less costly drugs with the same indications. There are valuable references that list drugs by use, and consider price and side effects.

The paper in the Journal of the American Board of Family Medicine advises “Physicians must openly communicate with patients about their financial situation and, ideally, make referrals to medication and basic needs assistance programs. Such assistance programs often require lengthy waits; in the meantime, physicians can help patients prioritize spending in a manner most conducive to good health, as medications may not always be the most urgent need.” This applies to pharmacists as well. The healing professions should recognize the traits that lead patients to understand the priority of needs, and know what programs are available for assistance – and patients should be prepared to discuss their finances as well as their blood pressure.

Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sam.uretsky@gmail.com

From The Progressive Populist, January 1-15, 2025

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