Costs Block Millions Of Prescription Access: Study

December 3, 2021 – Senate Democrats debate the Build Back Better Act, which includes mitigation measures. Prescription drug costs For consumers, new Urban Institute Studies 12.8 million adults delayed or did not receive the required medication due to cost.

These included 2.3 million elderly people who had deferred or left without prescription drugs Medicare Beneficiaries, 3.8 million adults with private insurance, 1.1 million Medicaid Recipients, and 4.1 million adults who were uninsured at any point in the previous year.

National representative data came from 2018-2019, before the COVID-19 epidemic began. Researchers at the Urban Institute used data from the Medical Expenditure Panel Survey conducted by the Agency for Healthcare Research and Quality.

According to the study, 1 in 10 adults with year-round (9.5%) or part of the year (11.6%) had unsafe drug requirements, compared to 4.9% of Medicare enrollees, 3% of unmarried privately insured adults, and 5.6. % Of adults with Medicaid.

Medicare beneficiaries and privately insured adults, women, low-income people, and people with very old conditions did not meet the need for prescription medication. More than 6 million adults with Medicare or private insurance have delayed or stopped taking essential medicines due to cost.

Nearly all Medicare members and 82% of privately insured adults who did not meet their medical requirements had one or more chronic conditions such as: High blood pressure, High cholesterol, stroke, diabetes, arthritis, and respiratory diseases. Studies show that when people are diagnosed with this condition and cannot get the medication they need, their outcome is likely to be worse.

The study found that a large proportion of Medicare members with a very chronic condition (5.6%) had difficulty paying for prescription medications rather than any condition (1.5%) or just one condition (1.7%). Of the unmarried adults with private insurance, 5.4% reported not being able to buy their medication due to multiple conditions, compared to 1.5% who had no condition and 2.3% who had a condition.

Medicine cost and ability to pay

Overall, prescription drugs contributed up to 14% of national health spending during the study period, the study said. In contrast, drugs account for about 22% of out-of-pocket costs for Medicare members and about 17% for privately insured individuals.

Like spending on other types of health care, out-of-pocket spending on prescription drugs is highly concentrated in certain groups of people. Of the privately insured unmarried adults, 5.3% spent more than 1% of their family income on prescription drugs; 6.1% reported out-of-pocket expenses above $ 500; 2.3%, over 1,000; And 0.8%, more than 2,000.

Out of the 25.4% of Medicare beneficiaries, out-of-pocket spending on prescription drugs exceeded 1% of household income, and 3.4% spent more than 10% of their household income on drugs. Personal spending on drugs for 21.5% of this group exceeds 500; 8.9% of Medicare members spent more than 1,000; And 2.7%, more than 2,000.

More than 7% of Medicare beneficiaries are reported to have spent more than $ 2,000 on prescription drug needs. Only 2.3% of adults with privately insured insufficient medicine reported the same.

The Build Back Better Act will have a big impact

The 1.3 million Medicare beneficiaries who spent the most on prescription drugs will be directly affected by the Build Back Better Act, which limits prescription drug spending to िके 2,000 for Medicare members.

Among other things, the report said, the work:

  • Allow Medicare to negotiate prices for some of the higher priced drugs covered by parts B and D.
  • Limit to beneficiary cost sharing Insulin Up to $ 35 per month for people with Medicare and business plans.
  • In the early stages of Part D, from 25% to 23% less cohabitation
  • Establishment of mandatory discounts for medicines covered by Medicare with prices rising faster than inflation
  • Increase incentives for Part D to negotiate lower prices with manufacturers

What’s more, the Build Back Better Act is passed Health insurance Affordable for the uninsured, as well as people living in states who have chosen not to expand Medicaid. Affordable Care Act, Study notes. Coverage expansion will make it easier for currently uninsured people to purchase the medicines they need.


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