Drug Cost Burden Increasing for Patients

Pill Bottle and Dollar Sign

Prescription medications can add up to huge costs, with more people now spending $50,000 and up a year.

Illnesses can be sudden or can involve chronic conditions, but either way the cost of medical care can be a huge financial strain. Now a new report reveals that more than half a million Americans spend at least $50,000 a year on their medication, and that number seems to be rising.

The report from Express Scripts, which looked at data from 31.5 million insured patients, reveals some shockingly high numbers. 576,000 American patients spent $50,000 or more on their medications in 2014, which was an increase of 63 percent more patients from the year before. That is not even the worst of it, with some patients spending $100,000 or more on their drugs. The number of people spending that much had increased from 47,000 in 2013 to 139,000 in 2015, almost triple the number.

The report seems to indicate that the $100,000 spenders are quite sick. More than a third of those patients were receiving treatments for ten or more medical conditions and almost two thirds were spending money on more than ten different prescriptions. The majority of the patients spending the most were Baby Boomers, according to the report. In all, these patients racked up $52 billion in drug bills in 2014.

Luckily for the high cost patients, they did not have to foot the entire bill themselves. The statistics showed that employers or insurance plans paid 98 percent of the drug costs for the $100,000 plus patients, working out to about $157,000 per patient on average. The average $100,000 plus patient only had to pay about $2,800 out of pocket. That said, even a few thousand dollars a year can be a huge strain for seniors or for families on a tight budget. Plus, some of the spending is on chronic conditions that can be a financial strain for many years.

There are a few different reasons for this jump in drug spending it seems. Part of the problem is the aging Baby Boomer population, who are experiencing more health issues related to aging. About two thirds of the $100,000 plus patient drugs were related to cancer care, which had about a $100 billion cost overall last year according to the Institute for Healthcare Informatics (IMS). As well, about seven times more patients were taking hepatitis C medication last year. Specialty compounded drugs also contributed more to the cost, although these can be important for specialized treatments, especially for patients that have allergies to some common drug ingredients and fillers. Blood pressure medications were commonly prescribed to patients at all spending levels, contributing to the overall cost.

A major contributor to the sharp increase in drug costs in 2014 compared to previous years is the huge jump in the cost of individual drugs. Gilead Sciences has faced some controversy over the cost of their hepatitis C medication Sovaldi. Their innovative drug can cure the liver disease, but the cost is $84,000 for three months worth of medication. Similarly, the melanoma drug Yervoy, made by Bristol-Myers Squibb, can extend the life of terminal patients by a year, giving them precious time to spend with their families and friends. However, this comes at a cost of $120,000 per treatment. Even the costs of generic medication, once a way for patients to save money over buying name brands, have increased recently.

A cost of $50,000 a year or more for drugs is a huge number when put in the perspective of the average American. That figure is more than the average salary, and when added to other expenses like rent or groceries, it could be a huge strain for the uninsured and under-insured, not to mention those that still cover a large percentage out-of-pocket beyond their insurance coverage. While the cost for the average patient in 2014 was $1,370, even that cost can still be a strain on a tight family budget.

Those that are uninsured often turn to purchasing their prescriptions at an online Canadian pharmacy, since many countries place limits on what drug companies can charge for their medications. Unfortunately, many other American patients simply stop taking their needed medication altogether because they just cannot afford the high cost. This could lead to even greater healthcare costs down the road, or worse.

In response to the high cost of drugs, some insurers are pushing harder for better deals from the drug manufacturers. Others are limiting which medications are covered by their health plans. Meanwhile, some patients just struggle more to find the money they need for their medical care.

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