High-Price Drugs Out of Reach for Many on Medicare
By Bianca Frogner, PhD
April 26, 2022
Bianca Frogner is a professor in the Department of Family Medicine and Director of the Center for Health Workforce Studies at the University of Washington School of Medicine. Her research focuses on how the health workforce can be used effectively to deliver high quality, accessible and affordable care.
The high cost of prescription drugs can make them hard to access, especially very high-cost treatments for conditions such as hepatitis C and immune system disorders. The problem is even worse for people with low incomes. Medicare does offer subsidies to help beneficiaries who make less than 150% of the federal poverty level afford and fill their prescriptions. But how well do these subsidies work?
A recent Health Affairs study led by Stacie Dusetzina shows these subsidies do improve access to some of the costliest treatments on the market for conditions like cancer and hepatitis C. The authors compared how subsidies — which can make a nearly $700 drug cost as little as $10 — impacted whether someone filled a drug within 90 days of it being prescribed.
This might sound easy, but it’s actually really hard to find out whether someone got a new prescription from the doctor but never filled it — and precisely what condition that prescription was for. So the researchers painstakingly connected several years’ worth of data from prescriptions written at 11 different health systems with electronic health record and Medicare claims data, which together showed what they were for and whether they were ever filled.
The key findings were:
On average, beneficiaries without subsidies were 37% less likely to fill their prescriptions than those who had any subsidy.
People with subsidies filled prescriptions for all conditions at much higher rates, with the exception of a smaller difference for hepatitis C medication.
1 in 3 beneficiaries without a subsidy did not fill their prescriptions for cancer drugs.
Even among people who had a subsidy, between 10 and 40 percent did not fill their prescriptions across four different conditions.
The study noted several limitations including the data only being for patients in a handful of systems and a lack of information on the severity of disease, patient preferences, adverse effects from drugs and availability of other subsidies — like those through the VA system.
This research has clear implications for policy: Broader subsidies or lower prices are needed to support access to prescription drugs. The authors call for a redesign of Medicare Part D, something proposed in President Biden’s Build Back Better legislation (now stalled in the Senate). They suggest that policymakers consider limiting both monthly and annual Part D out-of-pocket spending. For more on this study, don’t miss an interview with Dusetzina on the Health Podyssey podcast and her excellent tweetorial.