Big Pharma, Bigger Gaps in Healthcare

Big Pharma, Bigger Gaps in Healthcare



Prescription drugs now account for almost 17% of personal healthcare expenditures – up from about 7% in the 1990s – according to the federal Health and Human Services Department. Massive price increases for pharmaceuticals like the EpiPen stem from complex regulatory and supply chain issues in the U.S. drug market. As plan sponsors change their drug formularies and navigate tricky contracts with pharmacy benefit managers, consumers are digging deeper into their own pockets to pay for necessary medicine.

Today, Americans are struggling with enormous price hikes for Insulin (life-saving treatment for diabetic patients), Nitropress (used to treat hypertension) and countless other prescription medications essential for managing chronic conditions.

When out-of-pocket drug costs rise, patients are more likely to delay refills or skip doses to stretch their healthcare dollars. In a HealthMine survey of 509 Americans with diabetes, nearly half (44%) said they have avoided seeing a doctor/filling a prescription because of cost. The side effects are dangerous.

Skipping doses can result in a loss of control over chronic conditions that need careful management. For example, 73% of diabetic patients reported difficulties in coping with their condition, and 66% felt their diabetes was not totally under control. Loss of condition control can snowball into co-morbidities and unnecessary utilization—more costs piling on top of costs.

With little relief in sight for the epidemic of rising drug prices, what can plan sponsors do immediately to help consumers and themselves? Offer and encourage price comparison.

Drug prices can vary widely from pharmacy to pharmacy. Despite this, 70% of Americans still don’t price shop for healthcare services including prescription drugs. What’s more, less than a third (29%) of plan sponsors offer a price comparison tool in consumer wellness programs.

The U.S. is just beginning a likely years-long process to remedy the deficient pharmaceutical drug market. But in the meantime, plan sponsors can help guide members to the lowest-possible-cost choices available.

[Photo credit: Jamie on Flickr via Creative Commons]