Altonya Sheppard, 37, of Philadelphia, PA, is uninsured and doesn't think the insurance she'll be able to get in the health insurance marketplace will be either affordable or cover enough of her multiple medications. / Eileen Blass USAT
Altonya Sheppard, 37, just got out of the hospital - again.
She's on 11 medications, including three different inhalers for her asthma, but can't afford to buy them all. So she has to decide between heart medication, pain medicine for her arthritis and her inhalers. One inhaler alone costs her $180 a month even when she pays on a sliding scale through her part time job at a Philadelphia health clinic. About twice a year it lands her in the hospital.
"Some of them can get for $4 from my job, some of them are $20 a piece," says Sheppard, who works as a certified peer specialist outreach worker. "It depends on which one I'm getting, which one I decide to take for the month."
A report out today by a coalition of medical and consumer groups concludes poor adherence to medications among patients with multiple chronic conditions has reached "crisis proportions" in the U.S. It leads to "unnecessary disease progression" and complications and too many emergency room visits, hospitalizations and avoidable hospital re-admissions, says the National Council on Patient Information and Education.
"We see people again and again and again for conditions that are treatable," says Dr. Jim Bailey, an internist at a Memphis hospital's outpatient clinic. "Patients don't want to admit they can't afford their medications."
Caring for the more than a quarter of Americans with multiple chronic conditions accounts for 66% of the nation's health expenditures and is a major source of Medicare spending, the report concludes.
Among the solutions recommended by the coalition were lowering or eliminating co-payments for medications used to treat the most common chronic diseases. The group is also pushing pharmacies to better coordinate patients' medications, among several other recommendations.
"For people in the lower income range, the evidence is overwhelming that even small co pays discourage use," says Bailey, also a professor at the University of Tennessee Health Science Center.
As for who picks up this additional cost of the drugs, the group isn't saying.
"We have not suggested the government underwrite the costs for all medications," says Ray Bullman, executive vice president of NCPIE. "But forestalling the downstream consequences is a lot more economically responsible than not."
As Bailey notes, many hospitalizations that cost as much as $20,000 could be prevented through access to $300 to $500 worth of medications. Sheppard says she currently has bills she can't pay for hospital stays that cost $1,200 and $4,000.
Prescription drugs will likely be less affordable for many people with insurance next year, says David Isenstadt, an insurance broker and owner of New England Insurance Group in Guilford, Conn. As private insurers try to bring their plans more in alignment with the plans sold on the public exchanges, they will be requiring people to pay a certain percentage of their drug costs rather than a co pay, he says.
"I think a lot of average employees who work for small businesses, or people who buy coverage individually are going to be unpleasantly surprised how much their spending on prescription drugs may increase," says Isenstadt.
His own family's out of pockets costs for prescriptions would nearly quadruple to $450 under a typical 2014 plan compared to the type of plan he has now.
And according to Sheppard, the new health care law may be of little help.for her situation.
She's still trying to get far enough into the glitch-ridden system to determine precisely what she would have to pay a month. But even with the $1,500-a-month subsidy she would get, buying one of the low cost plans would cost her more than she now spends now for drugs and health care. And at least she's allowed to pay for her inhalers in installments, something she wouldn't be able to do with insurance.
"I'll be back to picking and choosing what to pay for like I'm picking and choosing now," she says.
And Sheppard is still relatively young. Six years ago, NCPIE declared prescription drug adherence "the other drug problem," but issued its new report based on new evidence that it's increasingly common for older Americans to take multiple medicines for a variety of chronic conditions. The average number of drugs prescribed increases from five at age 65 to seven at age 85, the group says.
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