The Hill

Americans Struggle When Insurance Won’t Cover Prescription Drugs

Buying prescription drugs has been a growing problem in the U.S. A new analysis found that many Americans struggle to get the right and effective medications for both mild and serious conditions due to increasing costs and very limited coverage by health insurance companies.

Having a health insurance plan can help improve health. However, some companies do not provide services that cover the drugs prescribed by most doctors, according to a poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

That leads people to taking less familiar medications or not getting any treatment at all. In 2019, more than one-third of adults from all income groups said that they or a household member failed to take a drug prescribed by their doctor despite having a health insurance plan.

The poll involved 1,885 American adults. Problems with insurance coverage greatly affected lower-income adults, with 49 percent of respondents failing to get prescription drugs in the past year. 

However, the number was also high among people with higher income. NPR and the team found that limited health insurance plans affected 41 percent of the highest-income adults and 32 percent of middle-income adults.

More than 51 percent of the respondents who reported less than $35,000 of income a year did not fill prescriptions. The same problem was reported by 48 percent of those who earn between $35,000 and $99,999.

“What you see is insurers are not paying for some drugs that physicians are recommending and that patients think they need,” Robert Blendon, head of the poll and a professor at the Harvard T.H. Chan School of Public Health, said. “Half of the people who are lower or middle class are not getting them … because they can't afford to go out and pay for it themselves.”

Increasing Cost Of Drugs

The poll also shows that even top earners in the U.S. avoided prescription drugs when their insurance did not cover it. Those people receive more than $500,000 a year. 

That was the case of Peggy Greenman of Baltimore. The 76-year-old was diagnosed with a precancerous lesion on her nose but decided not to take the first prescribed cream because Medicare refused to cover the more than $900 treatment.

Greenman said she could afford the cream. However, she found it not necessary and asked her doctor for another option to manage the lesion.  

Drug prices have been significantly increasing in the past decades and, in the last five years, prices have “really reached a crescendo,” according to Families USA Director Frederick Isasi. Studies showed generic drugs made most of the increases, climbing up by 15 percent every year.

Holly Campbell, a spokesperson for the trade group PhRMA, blamed insurance companies and health care providers for the higher cost of drugs. She cited nearly 50 percent of spending for all branded medicines goes to payers, hospitals and other entities in the supply chain.

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