For all of us out there dependent on insulin and other life-saving drugs, legislation to lower drug prices cannot come soon enough. President-elect Joe BidenJoe BidenBiden: Democrats' spending plan is 'a bigger darn deal' than Obamacare Biden says he's open to altering, eliminating filibuster to advance voting rights Biden: Comment that DOJ should prosecute those who defy subpoenas 'not appropriate' MORE has vowed to reduce the cost of medications, and as a primary care physician, I remain cautiously optimistic.
A week doesn’t go by when one of my patients reports that they cannot fill their prescriptions because the out of pocket cost is simply too expensive, especially if they are on a fixed income or have insurance with a high deductible or no pharmacy benefit. Even when they try using coupons, shopping around at different pharmacies, mail ordering and, in rare cases, obtaining a discount directly from the pharmaceutical company, they simply can’t afford it. They end up rationing what they have which is dangerous. In some cases, it’s deadly.
For those dependent on insulin and other life-saving drugs, preventing serious and very costly medical complications is critical. These medications are not a choice. Life depends on them. Ultimately, if a patient can’t take critical medications and as a result needs hospitalization, it will end up costing the insurer more than the drug itself.
Insulin, anticoagulants, immunosuppressive agents, inhalers, medications to lower blood pressure and cholesterol, Epipens — the list goes on — are too expensive for the average consumer. People with chronic medical conditions, who are often prescribed an average of nine prescription medications, need legislative action. The issue is even more urgent now, as so many people have lost their jobs and health insurance because of the COVID-19 pandemic and a Supreme Court case threatens the Affordable Care Act (ACA).
Before COVID-19, advocacy groups rallied vigorously through campaigns to bring a sense of urgency to the problem, including organizing regular caravans across the border to Canada to purchase insulin at a lower cost and lobbying Congress to pass legislation to regulate the pharmaceutical industry profiteering off diabetes.
President TrumpDonald TrumpHarris stumps for McAuliffe in Virginia On The Money — Sussing out what Sinema wants Hillicon Valley — Presented by Xerox — The Facebook Oversight Board is not pleased MORE touted that because of his actions, insulin was “so cheap it’s like water.” That’s completely false. In July 2020, Trump signed four executive orders directing the secretary of Health and Human Services to curb prescription medication costs. So far they haven’t brought down costs, despite further revision in September.
During his campaign, Biden supported repealing the law that prevents Medicare from negotiating for lower drug prices with manufacturers. He has also recommended creating panels that will be tasked with recommending price limits when competition for new drugs is lacking, that out-of-pocket limits be capped under Medicare Part D for outpatient drugs and that consumers be allowed to buy drugs from other countries.
Advocacy and legislation also need to continue at the state level. In Colorado, lawmakers capped the cost sharing for insulin to no more than $100 per month for those with health insurance. While $1,200 per year out-of pocket can still cut into grocery and utility bills for many families, it is a start.
Retailers have also tried to curb costs if they are able to make a direct deal with the manufacturer as Walmart did for Novolin, an older insulin. While this is an option for some, such deals do not go far enough. Middlemen in the supply chain need to be eliminated. Manufacturers Eli Lilly, Novo Nordisk and Sanofi and major insurers worked with Medicare to add a new insulin benefit under Part D that would cap the cost of insulin to $35 a month starting in 2021. This is good, but as a pilot program under Medicare Part D, it will only be available to certain subgroups, and for how long we don’t know.
We have a model for covering life-saving treatments. In 1967, the Gottschalk report sounded the alarm about the high cost of dialysis for those with end stage kidney disease. In 1972, the U.S. Congress passed legislation authorizing the End Stage Renal Disease Program (ESRD) under Medicare. This extended Medicare coverage for dialysis treatment so everyone who needed this life saving treatment was able to access it.
With the start of this new administration, the time has come to take care of people. Health care is a right, not a privilege of the wealthy. We should support Biden’s proposals and help those who are unable to afford essential high cost medications, such as insulin and many other common, life-saving medications. There is nothing more expensive than a preventable emergency room visit or hospitalization.
Dr. Stephanie Eisenstat is an internist specializing in chronic disease management at Massachusetts General Hospital and faculty at Harvard Medical School. She is also a public voices fellow with The OpEd Project.