The consequences of high out-of-pocket medication costs
Aging baby boomers with chronic conditions face tough treatment choices
Adherence to doctor-prescribed treatment regimens is critical to the health of many baby boomers living with chronic conditions such as rheumatoid arthritis, multiple sclerosis, diabetes, lupus, hepatitis C, and many others. Increasingly, however, the cost of treatment is unnecessarily forcing this population — many of whom have limited incomes and are close to retirement — to choose between paying for their medications and paying for food, rent, or other necessities for their families and themselves.
At present, a number of barriers stand between the more than 65 million U.S. baby boomers and affordable, timely access to medical care.
Some health insurers, for example, have begun driving up patients’ out-of-pocket costs for vital medications, which is putting the cost of treatment beyond the reach of many patients.
Rather than pay a fixed, predictable copayment, many patients are now often forced to pay coinsurance — or a percentage of the total cost of the drugs. For some patients, the cost of a single medication may mean hundreds or thousands of dollars in additional out-of-pocket costs every month.
When patients cannot afford their medications, they either undertreat their conditions or stop treatment altogether. Nonadherence to physician-prescribed treatment regimens can lead to more rapid disease progression and deterioration in health.
Unfortunately, the effects of burdensome out-of-pocket costs are not limited to the health of individual patients. When patients are forced to abandon their prescriptions, it can lead to increased healthcare costs to the system, in the form of unnecessary hospitalizations, emergency services, and physician visits.
Nonadherence results in $100 billion in annual direct costs to the healthcare system and $2 billion in annual lost patient earnings and productivity.