*Patient names have been changed
As doctors, health policy researchers, and citizens, we can’t help but think about our patients whenever the national debate around drug prices resurfaces, especially because we know that no one is immune to the effects of rising costs. Recently, one of our colleagues cared for Jacob*, an otherwise healthy 10-year-old who developed stomach pains and nausea 4 days after a diagnosis of COVID-19. His parents took him to the doctor and found that his blood sugars were three times higher than the normal level. He was diagnosed with type 1 diabetes and had to be started immediately on insulin to bring his blood sugar levels down and help him feel better. However, his parents soon realized that insulin would now be a lifelong medicine required to keep their son alive. Jacob’s parents, like millions of Americans, did not have a health insurance plan with sufficient prescription drug coverage and were suddenly saddled with the stress of paying for this essential medication every month.
We know that stories like Jacob’s are far too common, and as a result, we believe in the idea of pharmacoequity: a world where every patient who needs medicine can access it in a way that is affordable and timely. Unfortunately, this goal has eluded the US for decades. While nearly 50% of people in the US used a prescription drug in the past 30 days, almost 7% of Americans report difficulty paying for prescription medications. Meanwhile, 90% of Americans report supporting policy changes to lower the cost of drugs. While it is clear that no single policy solution would be a cure-all for the problem of skyrocketing drug prices, we outline below three reasonable, bipartisan provisions that Congress could implement to substantially improve the quality of our patient’s lives.
First, we believe injectable insulin should be widely available, as its inventors encouraged 100 years ago when they declined to be named on the patent. Among insulin users covered by Medicare Part D, the average per-month out-of-pocket cost of insulin rose from $27 in 2007 to $48 in 2017, far outpacing the rate of inflation. About one in four patients at the Yale Diabetes Center reported not taking insulin as prescribed by their doctor in a given month because of cost. Rationing insulin therapy results in worse diabetes control and can lead to sickness, hospitalization, and even death.
Senator Raphael Warnock (D-Ga.) and Rep. Angie Craig (D-Minn.) have championed the Affordable Insulin Now Act, which would cap insulin copays at $35 each month for patients covered by Medicare Part D or commercial insurance. The House has passed its version of the bill, and the Senate version is waiting for further discussion in the Finance Committee. We are hopeful about the potential of this bill, but what about the uninsured? We must support advocates calling for price caps to be extended to limit insulin-related costs among uninsured patients with diabetes. The bill should also be accompanied by other more comprehensive steps because, as the bill is currently written, drugmakers and insurers could recoup lost insulin profits from patients in other ways, such as increasing insurance premiums or the cost of other medications.
That leads us to our second possible reform: capping out-of-pocket costs altogether, not just for insulin. We primarily take care of adults in our clinical work, so we see many patients who get their medications through the nation’s largest health insurance plan: Medicare. Despite Medicare’s ever-growing prescription drug spending, more than 5 million Medicare beneficiaries struggle to afford their medications. These Americans are 1.5 to 2 times more likely to identify as Black or Latinx. Currently, once our patients go beyond the limits of their Medicare coverage, they are subject to potentially unlimited costs for their medications that would not be reimbursed. If it had advanced in Congress, the Prescription Drug Price Reduction Act of 2019 could have amended the design of the Medicare Part D benefit by adding a hard cap on out-of-pocket spending. Recent provisions outlined in the Build Back Better Act incorporated a $2,000 annual cap. This $2,000 cap would be a significant improvement for Medicare patients without any spending limit, and implementing such a cap could protect them from being caught between insurers and drug manufacturers in the struggle over whose profit margins could shrink.
Finally, while prescription drug insurance reform is key, we also believe that costs should be addressed with manufacturers directly. For example, the Medicare Part D statute says that Medicare “may not interfere with the negotiations between drug manufacturers and pharmacies and prescription drug plan sponsors.” Over 80% of Americans across the political spectrum support legislative proposals that would amend that law to allow Medicare to negotiate prices. Recent proposals would allow Medicare to step in and negotiate prices for up to 20 drugs that, like insulin, have been on the market for upwards of 12 years.
Drug makers and their proponents will argue that these and even more comprehensive reforms will take away hundreds of millions of dollars in profit from the pharmaceutical industry, thereby hindering the development of future drugs. These statements do not alarm us because as physicians, researchers, and healthcare consumers ourselves we know from experience that the price-gouging of medications that came to market years ago has not resulted in dramatic innovation for our patients, like Jacob, with chronic illnesses. Rather, it threatens their ability to lead meaningful, happy lives for the sake of profit and stock buybacks.
Policymakers face a choice: let prescription drug costs continue to rise unchecked, placing patients and families at continued risk, or pass sensible reforms that would make drugs more affordable for all Americans. No one should have to decide between basic needs like food and shelter and life-saving medication. The policies we have highlighted have the support of millions of Americans, and our prescription is to pass them soon.
Alexander Reardon, MD, is an incoming resident in the Department of Emergency Medicine at the Northwestern University Feinberg School of Medicine. Utibe Essien, MD, MPH, is an assistant professor of medicine at the University of Pittsburgh. Jing Luo, MD, MPH, is an assistant professor of medicine and a researcher at the University of Pittsburgh Center for Pharmaceutical Policy and Prescribing. Quentin R. Youmans, MD, MSc, is a fellow in the Division of Cardiology at Northwestern University Feinberg School of Medicine.
The opinions expressed in this piece are the authors’ own.