Meghan McFarland
Adam Korman
ENG 102
3-15-24
Americans Are Increasingly Unable To Afford Their Medication
The people of the United States pay more for prescription drugs than anywhere else in the world. There is a continual rise in the cost of drugs and yet the lowering of its accessibility are leaving numerous Americans to be forced to forgo these life saving medications. The accessibility of affordable healthcare and prescription medication has historically been a struggle changing throughout the decades by continually changing legislation. Throughout the years, both state and federal governments have enacted legislation to combat high prices but high drug prices remain due different political views on the government's role in setting prices, misinformation and lack of education, and controversial tactics of pharmaceutical companies focused on profit over patient care. Fortunately, there are both short and long term solutions such as increased legislation, drug price transparency, and the movement towards a federally funded united health care system offering free care for American citizens.
The history of prescription drug price legislation was intended to progress with the value of accessibility and affordability while encouraging new innovations. In the early 19th century, there was a lack of regulations that controlled the conditions drugs were made in, their contents, and specific prices were dictated by the market. The more modern age of medication regulation began with the passing of the Food and Drugs Act in 1903 and then its replacement known as the Federal food, drug and cosmetic Act in 1938. These laws set a basis for the beginning of government involvement in drug sales to help regulate prescription drug prices. In 1958, "The first pharmacy benefit managers (PBMs) were established to manage prepayment plans for prescriptions." This system was created to negotiate with pharmacies to make drug prices while keeping them accessible to the people. As the healthcare system in the United States evolved, the emergence of new diseases throughout the decades greatly impacted the price of medication. Companies grew and prices continued to rise and with the "emergence of HIV/AIDS and related activism led to changes in access to experimental drugs and the drug approval process. The end of the decade also ushered in a new era of drugs with five-figure price tags." The still lax control over drug prices let new brand name medications hike these prices significantly but with the enacting of Medicare Part D, apart of the Medicare Prescription Drug, Improvement, and Modernization Act, this insurance program gained the ability to cover prescription drug costs outside of a hospital setting which helped to relieve some of the rising costs off of consumers. Big pharmaceutical companies then began to vertically integrate and managed to take great control over the public's ability to access and afford medications (Nelson). As the problem of unaffordable drug prices still remains a source of pain for many Americans, this issue continues to be a huge debate in major politics over the role of government's responsibility to enact fair legislation.
Due to increased demands from Americans needing access to affordable medication, current legislation has evolved to address these issues. Additionally, Big Pharma has been accused of various practices to inflate drug prices for profit. To combat that problem, government intervention has been necessary. For example, on the federal level, "The government agency, the FTC, sued the three largest PBMs alleging they artificially inflated their prices for insulin to boost profits." Legislation is also being enacted at the state level as seen by the "Texas Attorney General sues the three biggest insulin manufacturers" over a conspiracy that the manufacturers knowingly raised the price of insulin and then passed profits to PBM's who in return granted a preferred status to whichever manufacturer secured the highest list price while excluding cheaper drugs. To explain what drug importation means to combat high prices, Americans are attempting to import drugs from other countries like Canada who sell medications at lower prices. As this importation is expected to increase more foreign drugs into the United State, "several states, including Colorado, Vermont, Maine, New Mexico, New Hampshire, North Dakota and Texas have enacted law" (Nelson). to establish programs that would help counter patent abuse keeping American prices high. Biden, during his presidency, had shown effort to help lower prices by enacting the Executive Order 14087 and the Reduction Inflation Act of 2022 as well as introducing concepts such as Medicare $2 Drug List Model, Cell and Gene Therapy Access Model, and Accelerating Clinical Evidence Models (Brown). These types of legislation are all aimed to reduce prices of the American people's prescriptions purchased domestically.
The need to have affordable medication is an issue that affects many Americans and high drug prices have prevented patients from proper care. Currently, there are
"More than 131 million people - 66 percent of all adults in the United States - use prescription drugs"("How Do Prescription Drug Costs"). Some of these patients have private insurance, reduced or free healthcare such as Medicaid or Medicare, or no health insurance at all. The effects of not having readily available access to needed treatment has been detrimental to the health of American citizens. This results in patients not taking the medication or taking lower doses due to the high cost. According to Nisha Kurani "About three in ten adults report not taking their medicines as prescribed at some point in the past year because of the cost"("How Do Prescription Drug Costs"). This delay in care causes people's health condition to worsen leading to required extended treatment and potential life long issues. This also causes further strain on an already fractured health care system. Additionally, due to financial constraints, some patients are having to choose between paying essential bills like rent or groceries or fulfilling sometimes life saving medications prescribed by their physicians. In one such case "Trapp, 59, a former high school teacher and realtor from Muskego, Wis., was diagnosed with multiple myeloma in 2015 and prescribed Revlimid to manage her disease." and for Trapp to afford this medication "her and her husband had to dig into their savings, take out two mortgages and sell some of their belongings including her car and her husband's classic truck" (Nelson). Having citizens choose between basic necessities or delaying treatment due to the high cost of medication has widespread social ramifications that have yet to be sufficiently addressed.
While there are those that don't believe high drug prices are an issue, this is most likely attributed to lack of education and misinformation. "About eight in ten adults (82%) say the cost of prescription drugs is unreasonable"("Public Opinion on Prescription Drugs"), Others believe that "Most drugs dispensed are generic, and only the prices of brand-name blockbuster drugs are increasing dramatically." Another misconception is that high drug costs are needed to support drug innovation. However, "Eight out of 10 major drug manufacturers spend more on advertising than on research and development - unnecessary spending that they instead could put toward research and development or lowering the cost of a drug"(American Hospital Association). Additionally, huge pharmaceutical companies bring in billions in revenue that much overshadow the cost to fund research and new scientific developments. This brings up a point that even with enough funds to maintain a wealthy company and simultaneously nurture drug research, pharmaceutical companies choose to fund the strategy that brings them the most profits over peoples health.
Another driving force preventing the effective combat and resolution to high drug prices is unfair practices by Pharmaceutical companies. Some of these practices include profit driven motives, abuse of patent protections, patient steering, and the use of discount and saving cards. The focus by Pharmaceutical companies on huge profits is causing drug prices to remain unfairly elevated. According to tracking polls 83% of the political parties of the U.S. believe the biggest contributing factor to the skyrocketing drug prices are due to the profits that pharmaceutical companies rake in, followed by 54% that it is due to new research costs, and 45% from marketing costs ("Public Opinion on Prescription Drugs"). The cost of new drug research, marketing of the medication and the need for high profits is inflating some drug prices to astronomical rates. A drug patent process is when a company invents a drug and is allowed to exclusively sell it for up to 20 years with the purpose of getting reimbursed for the costs of the drugs creation. After this patent expires and is not renewed, any other company is allowed to sell generic versions of that drug often at a significantly reduced price.
"A health writer describes mounting pressure from the Federal Trade Commission and Congress to clamp down on strategies pharmaceutical companies use to extend patent protection to prevent competition from generics and biosimilars" (American Hospital Association). A way the patent extending process is taken advantage of is when manufacturers minimally change drug formulas to prevent generic alternatives. Simply changing the dosage or method of delivery of a drug can be enough to be granted an extension even if the resulting product is not more effective than its predecessor. Some companies "preemptively withdraw an off-patent drug from the market to make way for a newly patented successor." An example of this can be seen when in September of 2012, British-based Reckitt Benckiser Pharmaceuticals made the move to abruptly announced that it was discontinuing the widely used buprenorphine/naloxone (Suboxone) tablets, which treat addiction to heroin and opioid painkillers, in favor of a new format: a film that, like the tablet, that dissolves under the tongue in order to extend the patent securing high price standards ("Novel Tactics Impede Generic Competition"). The pharmaceutical company is now being sued for rushing the new formulas to market without proper testing to again inflate prices. Another deceptive practice from Big pharma is labeled patient steering, in which companies channel their patients' prescription pickup location to a retailer they personally own. It is common in this practice to charge patients a higher out-of-pocket fee if they miss a 30-90 day deadline for pick-up and prohibit their prescription from being filled at any other location altogether even if they can find it at a lower price."New York Gov. Kathy Hochul, a Democrat, announced new state regulations designed to rein in unfair and anticompetitive practices of PBMs, such as steering consumers away from local pharmacies to those affiliated with PBMs." Many pharmaceutical companies also introduce savings cards to reduce the price of medication. While this coupon provides a lower upfront cost of a prescription, the reality of this sale is to drive patients towards more expensive options, brush off the cost to others through increased Medicare premium prices, and it does not cover all medications (Kaufman). In one instance,"The pharmaceutical industry sues the Biden administration in federal court over its plan to negotiate Medicare drug prices" (Nelson).
While it is evident that the issue of inflated drug prices is a crisis in America, there are various solutions that can bring down the cost of much needed drugs. One example is
mandated transparency from pharmacy companies on drug prices and from government news sources discussing healthcare topics. Another solution could be "regulating drug prices for the entire market through negotiations, we would likely see lower prices, more effective use of payers' resources and better health outcomes" (Nelson). This can be done by enacting new legislation that negotiates fair prices with drug manufacturers, and promoting fair drug competition from generic companies. Establishing clear guidelines and procedures for drug price negotiation, including timelines, data sharing, and dispute resolution mechanisms, would be crucial. Promoting the increased use and accessibility of generic drugs would also bring high prices. This can be accomplished by reducing bureaucratic hurdles and speeding up the approval process for generic drugs that can increase competition and lower prices. The most dramatic solution to this problem is a federally funded health care system that provides free healthcare and prescription drugs for all Americans. Canada's healthcare, for example, is funded publicly through taxes collected from its citizens unlike the U.S. currently whose healthcare is funded through a mix of private and public and out of pocket payments. This method has resulted in " Health expenditures in the United States average out at $12,914 per person, nearly double the $6,500 spent per person in Canada" ("U.S. vs. Canadian Healthcare"). Even though a large majority of Americans are plagued with unaffordable health care, many alternatives are available to combat inflated prices set by large pharmaceutical companies that often are focused on profits rather than patient accessibility.
With the newly elected Trump administration, federal funding has greatly been reduced and many people are worried that past legislation will be cut or significantly lowered or programs like Medicare and Medicaid will be completely gutted as part of his budget resolution. According to the House Committee On the Budget, "House Republicans' budget plans show they are 100 percent on board with Trump's Project 2025 agenda, which will give Big Pharma a windfall while putting the tens of millions of Americans who get their health coverage through Medicare, Medicaid, and the ACA, on the chopping block. While President Trump denied knowledge of a controversial reframing of the federal government named Project 2025, many ideas in the proposal have already been enacted. Project 2025 calls for the repeal of the Inflation Reduction Act which would increase millions of Medicare enrollees out of pocket costs. More workers in health care departments have already been fired or the staff, funding, and programs have already been reduced leaving many federal programs such as Medicare and Medicaid in uncertainty. Without these federal programs, it is almost certain less people will be able to afford their medications out of pocket without insurance. " For instance, one Biden-era initiative overturned by Trump had instructed Medicare to explore ways to reduce drug costs, including a potential $2000 monthly OOP cap on certain generic medications" ("Trump Reverses Some Biden Drug Pricing Initiatives"). Additional cuts in federal programs are also limiting grants to further innovations in treating diseases that in turn might help reduce or even eliminate the reliance on prescription medications to treat common illnesses. "President Trump's Administration is imposing a new policy to cap indirect costs for National Institutes of Health (NIH) research grants at 15 percent, which would cut billions of dollars in funding for life-saving research to develop cures and treatments for diseases" ("Trump Team Dismantles Efforts"). As a result of these new policies, more people will suffer or lose their lives to inaccessibility of treatment which affects everything for advancement in the treatment of diseases and the accessibility of much needed affordable medication.
The rising price and accessibility to affordable prescription medication is an ongoing issue faced by many Americans. While in the past, legislation has improved drug prices, many Americans still need to choose between healthcare and basic needs to live. Reducing deceptive practices by Big Pharma will help lower some drug prices, yet, healthcare should be a human right. Therefore, we need to stop putting profits by large corporations such as Insurance companies and large pharmaceutical companies above patient needs, and work towards a alternative solution whether it be increased legislation that demands affordable and fair prescription drug pricing or a more radical federally funded healthcare system like in countries like Canada and Europe that offer medication either free or at a greatly reduced price. This change starts with increased education, contacting your local representative to focus on these issues, and supporting and voting for congressional representatives to enact legislation to combat this issue.
Works Cited
Adam Korman
ENG 102
3-15-24
Americans Are Increasingly Unable To Afford Their Medication
The people of the United States pay more for prescription drugs than anywhere else in the world. There is a continual rise in the cost of drugs and yet the lowering of its accessibility are leaving numerous Americans to be forced to forgo these life saving medications. The accessibility of affordable healthcare and prescription medication has historically been a struggle changing throughout the decades by continually changing legislation. Throughout the years, both state and federal governments have enacted legislation to combat high prices but high drug prices remain due different political views on the government's role in setting prices, misinformation and lack of education, and controversial tactics of pharmaceutical companies focused on profit over patient care. Fortunately, there are both short and long term solutions such as increased legislation, drug price transparency, and the movement towards a federally funded united health care system offering free care for American citizens.
The history of prescription drug price legislation was intended to progress with the value of accessibility and affordability while encouraging new innovations. In the early 19th century, there was a lack of regulations that controlled the conditions drugs were made in, their contents, and specific prices were dictated by the market. The more modern age of medication regulation began with the passing of the Food and Drugs Act in 1903 and then its replacement known as the Federal food, drug and cosmetic Act in 1938. These laws set a basis for the beginning of government involvement in drug sales to help regulate prescription drug prices. In 1958, "The first pharmacy benefit managers (PBMs) were established to manage prepayment plans for prescriptions." This system was created to negotiate with pharmacies to make drug prices while keeping them accessible to the people. As the healthcare system in the United States evolved, the emergence of new diseases throughout the decades greatly impacted the price of medication. Companies grew and prices continued to rise and with the "emergence of HIV/AIDS and related activism led to changes in access to experimental drugs and the drug approval process. The end of the decade also ushered in a new era of drugs with five-figure price tags." The still lax control over drug prices let new brand name medications hike these prices significantly but with the enacting of Medicare Part D, apart of the Medicare Prescription Drug, Improvement, and Modernization Act, this insurance program gained the ability to cover prescription drug costs outside of a hospital setting which helped to relieve some of the rising costs off of consumers. Big pharmaceutical companies then began to vertically integrate and managed to take great control over the public's ability to access and afford medications (Nelson). As the problem of unaffordable drug prices still remains a source of pain for many Americans, this issue continues to be a huge debate in major politics over the role of government's responsibility to enact fair legislation.
Due to increased demands from Americans needing access to affordable medication, current legislation has evolved to address these issues. Additionally, Big Pharma has been accused of various practices to inflate drug prices for profit. To combat that problem, government intervention has been necessary. For example, on the federal level, "The government agency, the FTC, sued the three largest PBMs alleging they artificially inflated their prices for insulin to boost profits." Legislation is also being enacted at the state level as seen by the "Texas Attorney General sues the three biggest insulin manufacturers" over a conspiracy that the manufacturers knowingly raised the price of insulin and then passed profits to PBM's who in return granted a preferred status to whichever manufacturer secured the highest list price while excluding cheaper drugs. To explain what drug importation means to combat high prices, Americans are attempting to import drugs from other countries like Canada who sell medications at lower prices. As this importation is expected to increase more foreign drugs into the United State, "several states, including Colorado, Vermont, Maine, New Mexico, New Hampshire, North Dakota and Texas have enacted law" (Nelson). to establish programs that would help counter patent abuse keeping American prices high. Biden, during his presidency, had shown effort to help lower prices by enacting the Executive Order 14087 and the Reduction Inflation Act of 2022 as well as introducing concepts such as Medicare $2 Drug List Model, Cell and Gene Therapy Access Model, and Accelerating Clinical Evidence Models (Brown). These types of legislation are all aimed to reduce prices of the American people's prescriptions purchased domestically.
The need to have affordable medication is an issue that affects many Americans and high drug prices have prevented patients from proper care. Currently, there are
"More than 131 million people - 66 percent of all adults in the United States - use prescription drugs"("How Do Prescription Drug Costs"). Some of these patients have private insurance, reduced or free healthcare such as Medicaid or Medicare, or no health insurance at all. The effects of not having readily available access to needed treatment has been detrimental to the health of American citizens. This results in patients not taking the medication or taking lower doses due to the high cost. According to Nisha Kurani "About three in ten adults report not taking their medicines as prescribed at some point in the past year because of the cost"("How Do Prescription Drug Costs"). This delay in care causes people's health condition to worsen leading to required extended treatment and potential life long issues. This also causes further strain on an already fractured health care system. Additionally, due to financial constraints, some patients are having to choose between paying essential bills like rent or groceries or fulfilling sometimes life saving medications prescribed by their physicians. In one such case "Trapp, 59, a former high school teacher and realtor from Muskego, Wis., was diagnosed with multiple myeloma in 2015 and prescribed Revlimid to manage her disease." and for Trapp to afford this medication "her and her husband had to dig into their savings, take out two mortgages and sell some of their belongings including her car and her husband's classic truck" (Nelson). Having citizens choose between basic necessities or delaying treatment due to the high cost of medication has widespread social ramifications that have yet to be sufficiently addressed.
While there are those that don't believe high drug prices are an issue, this is most likely attributed to lack of education and misinformation. "About eight in ten adults (82%) say the cost of prescription drugs is unreasonable"("Public Opinion on Prescription Drugs"), Others believe that "Most drugs dispensed are generic, and only the prices of brand-name blockbuster drugs are increasing dramatically." Another misconception is that high drug costs are needed to support drug innovation. However, "Eight out of 10 major drug manufacturers spend more on advertising than on research and development - unnecessary spending that they instead could put toward research and development or lowering the cost of a drug"(American Hospital Association). Additionally, huge pharmaceutical companies bring in billions in revenue that much overshadow the cost to fund research and new scientific developments. This brings up a point that even with enough funds to maintain a wealthy company and simultaneously nurture drug research, pharmaceutical companies choose to fund the strategy that brings them the most profits over peoples health.
Another driving force preventing the effective combat and resolution to high drug prices is unfair practices by Pharmaceutical companies. Some of these practices include profit driven motives, abuse of patent protections, patient steering, and the use of discount and saving cards. The focus by Pharmaceutical companies on huge profits is causing drug prices to remain unfairly elevated. According to tracking polls 83% of the political parties of the U.S. believe the biggest contributing factor to the skyrocketing drug prices are due to the profits that pharmaceutical companies rake in, followed by 54% that it is due to new research costs, and 45% from marketing costs ("Public Opinion on Prescription Drugs"). The cost of new drug research, marketing of the medication and the need for high profits is inflating some drug prices to astronomical rates. A drug patent process is when a company invents a drug and is allowed to exclusively sell it for up to 20 years with the purpose of getting reimbursed for the costs of the drugs creation. After this patent expires and is not renewed, any other company is allowed to sell generic versions of that drug often at a significantly reduced price.
"A health writer describes mounting pressure from the Federal Trade Commission and Congress to clamp down on strategies pharmaceutical companies use to extend patent protection to prevent competition from generics and biosimilars" (American Hospital Association). A way the patent extending process is taken advantage of is when manufacturers minimally change drug formulas to prevent generic alternatives. Simply changing the dosage or method of delivery of a drug can be enough to be granted an extension even if the resulting product is not more effective than its predecessor. Some companies "preemptively withdraw an off-patent drug from the market to make way for a newly patented successor." An example of this can be seen when in September of 2012, British-based Reckitt Benckiser Pharmaceuticals made the move to abruptly announced that it was discontinuing the widely used buprenorphine/naloxone (Suboxone) tablets, which treat addiction to heroin and opioid painkillers, in favor of a new format: a film that, like the tablet, that dissolves under the tongue in order to extend the patent securing high price standards ("Novel Tactics Impede Generic Competition"). The pharmaceutical company is now being sued for rushing the new formulas to market without proper testing to again inflate prices. Another deceptive practice from Big pharma is labeled patient steering, in which companies channel their patients' prescription pickup location to a retailer they personally own. It is common in this practice to charge patients a higher out-of-pocket fee if they miss a 30-90 day deadline for pick-up and prohibit their prescription from being filled at any other location altogether even if they can find it at a lower price."New York Gov. Kathy Hochul, a Democrat, announced new state regulations designed to rein in unfair and anticompetitive practices of PBMs, such as steering consumers away from local pharmacies to those affiliated with PBMs." Many pharmaceutical companies also introduce savings cards to reduce the price of medication. While this coupon provides a lower upfront cost of a prescription, the reality of this sale is to drive patients towards more expensive options, brush off the cost to others through increased Medicare premium prices, and it does not cover all medications (Kaufman). In one instance,"The pharmaceutical industry sues the Biden administration in federal court over its plan to negotiate Medicare drug prices" (Nelson).
While it is evident that the issue of inflated drug prices is a crisis in America, there are various solutions that can bring down the cost of much needed drugs. One example is
mandated transparency from pharmacy companies on drug prices and from government news sources discussing healthcare topics. Another solution could be "regulating drug prices for the entire market through negotiations, we would likely see lower prices, more effective use of payers' resources and better health outcomes" (Nelson). This can be done by enacting new legislation that negotiates fair prices with drug manufacturers, and promoting fair drug competition from generic companies. Establishing clear guidelines and procedures for drug price negotiation, including timelines, data sharing, and dispute resolution mechanisms, would be crucial. Promoting the increased use and accessibility of generic drugs would also bring high prices. This can be accomplished by reducing bureaucratic hurdles and speeding up the approval process for generic drugs that can increase competition and lower prices. The most dramatic solution to this problem is a federally funded health care system that provides free healthcare and prescription drugs for all Americans. Canada's healthcare, for example, is funded publicly through taxes collected from its citizens unlike the U.S. currently whose healthcare is funded through a mix of private and public and out of pocket payments. This method has resulted in " Health expenditures in the United States average out at $12,914 per person, nearly double the $6,500 spent per person in Canada" ("U.S. vs. Canadian Healthcare"). Even though a large majority of Americans are plagued with unaffordable health care, many alternatives are available to combat inflated prices set by large pharmaceutical companies that often are focused on profits rather than patient accessibility.
With the newly elected Trump administration, federal funding has greatly been reduced and many people are worried that past legislation will be cut or significantly lowered or programs like Medicare and Medicaid will be completely gutted as part of his budget resolution. According to the House Committee On the Budget, "House Republicans' budget plans show they are 100 percent on board with Trump's Project 2025 agenda, which will give Big Pharma a windfall while putting the tens of millions of Americans who get their health coverage through Medicare, Medicaid, and the ACA, on the chopping block. While President Trump denied knowledge of a controversial reframing of the federal government named Project 2025, many ideas in the proposal have already been enacted. Project 2025 calls for the repeal of the Inflation Reduction Act which would increase millions of Medicare enrollees out of pocket costs. More workers in health care departments have already been fired or the staff, funding, and programs have already been reduced leaving many federal programs such as Medicare and Medicaid in uncertainty. Without these federal programs, it is almost certain less people will be able to afford their medications out of pocket without insurance. " For instance, one Biden-era initiative overturned by Trump had instructed Medicare to explore ways to reduce drug costs, including a potential $2000 monthly OOP cap on certain generic medications" ("Trump Reverses Some Biden Drug Pricing Initiatives"). Additional cuts in federal programs are also limiting grants to further innovations in treating diseases that in turn might help reduce or even eliminate the reliance on prescription medications to treat common illnesses. "President Trump's Administration is imposing a new policy to cap indirect costs for National Institutes of Health (NIH) research grants at 15 percent, which would cut billions of dollars in funding for life-saving research to develop cures and treatments for diseases" ("Trump Team Dismantles Efforts"). As a result of these new policies, more people will suffer or lose their lives to inaccessibility of treatment which affects everything for advancement in the treatment of diseases and the accessibility of much needed affordable medication.
The rising price and accessibility to affordable prescription medication is an ongoing issue faced by many Americans. While in the past, legislation has improved drug prices, many Americans still need to choose between healthcare and basic needs to live. Reducing deceptive practices by Big Pharma will help lower some drug prices, yet, healthcare should be a human right. Therefore, we need to stop putting profits by large corporations such as Insurance companies and large pharmaceutical companies above patient needs, and work towards a alternative solution whether it be increased legislation that demands affordable and fair prescription drug pricing or a more radical federally funded healthcare system like in countries like Canada and Europe that offer medication either free or at a greatly reduced price. This change starts with increased education, contacting your local representative to focus on these issues, and supporting and voting for congressional representatives to enact legislation to combat this issue.
Works Cited
