The time to act is now: Medicines and health care must be affordable for all - Healio

March 04, 2022

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The cost of prescription medicines in the U.S. continues to rise, and for many, lifesaving medicines such as insulin are inaccessible due to cost.

With one in four people in the U.S. reporting they cannot afford their prescription medicines and with steady increases in the price of drugs set by pharmaceutical companies, profits are being prioritized over patients, resulting in worsening health outcomes.

The U.S. spends more money on health care than any other nation in the world, yet since patients’ access to medicines and health care is dependent on every individual’s finances, health insurance status, employment and other socioeconomic factors, many people must forgo the care they need due to cost. This is unacceptable in the wealthiest nation in the world, but because our system does not consider health as a human right, we have continued to witness widening health disparities, particularly among historically underrepresented communities. These disparities have further accelerated during the COVID-19 pandemic.

Last year, efforts were made to address skyrocketing medication and health care costs in the Build Back Better legislative package, and there were calls to action to ensure that the legislation included several critical health provisions.

Although Build Back Better stalled in Congress at the close of 2021, during this week’s State of the Union address, President Joe Biden called on Congress to pass legislation supporting key health provisions to improve access to medicines and health care for everyone in our nation. We applaud the administration’s commitment to health equity and ensuring these issues are addressed, and we must collectively act to support these provisions which will benefit our patients and communities.

Among the health provisions that Biden highlighted during his speech were cutting the cost of prescription drugs by allowing Medicare to negotiate drug prices, capping the price of insulin to $35 per month, and permanently extending the American Rescue Plan’s Affordable Care Act marketplace health insurance premium subsidies. Biden also emphasized the importance of supporting families that are living paycheck to paycheck and investing in the American people.

Since health care costs are a leading cause of bankruptcy in the U.S. and it is essential for individuals to be healthy in order to support themselves, their families and their communities, our nation should invest in our families and enact policies that make medicines and health care affordable for all.

Access to prescription medicines is a health issue, not a political issue, and all people, regardless of political affiliation, should be able to access the medicines they need when they need them, regardless of cost, and we should not have to pay significantly more than other high-income nations for the same medications. Because of this, access to affordable medicines has broad bipartisan support in the larger U.S. population, and it is vital for Congress to work across party lines to swiftly enact legislation that will make medicines affordable for our patients and communities.

Specifically, Medicare must have the ability to negotiate the price of medicines in the same way that the Department of Veterans Affairs is currently able to negotiate prices. When comparing the price that the VA pays for medicines compared to the price that Medicare pays, the U.S. Government Accountability Office reported that the VA pays nearly half of what Medicare currently pays. If Medicare is allowed to negotiate drug prices, the savings generated will help fund other important health provisions.

It is also critical to cap the price of insulin, since it is an essential medication that is relatively cheap to produce but has prices that have been significantly marked up by pharmaceutical companies, leaving many people with diabetes unable to afford this life-sustaining and lifesaving medication. While there are current proposals to cap the price of insulin at $35 per month for those with health insurance, for those who are uninsured, insulin will remain financially inaccessible. As a result, we must advocate for insulin prices that are capped regardless of patients’ insurance status.

In order for our patients who are uninsured or underinsured to access the health care they need without risking their financial stability or having to choose between paying for housing and food or health care, we must enact policies that expand access to affordable care. It is therefore vital that we advocate for Medicaid expansion in states that have not yet adopted expansion, extend post-partum care in Medicaid to 12 months, particularly with worsening maternal mortality in communities of color during the COVID-19 pandemic, and permanently extending the American Rescue Plan’s Affordable Care Act marketplace health insurance premium subsidies, which is currently set to expire at the end of 2022. In addition, capping Medicare out-of-pocket costs, providing hearing, vision and dental coverage in Medicare, and ensuring 12 weeks of paid family and medical leave are critical for the well-being of our patients and communities.

We currently have a window of opportunity to act, and we cannot afford to stay silent. As physicians, we hold positions of privilege and power. Each day, our patients entrust us with their health and their stories. We have our fingers on the pulse of our communities and we know the feeling of despair when our patients break down in tears in the exam room because they cannot afford the medicines or health care that will save their lives or the lives of their children.

We cannot keep our patients’ struggles to ourselves or feel that our patients’ situations are helpless. We must lift the voices of our patients and share with our members of Congress and the administration the stories of our patients who are trying to do everything they can to stay healthy, but because of the lack of policies to make lifesaving medicines such as insulin affordable, they are developing severe complications or dying from diabetes because they are rationing or entirely forgoing taking their insulin due to cost.

We are at a critical juncture in our nation’s history. We cannot afford to let our opportunity to make medicines affordable for our patients slip by, and our patients cannot wait. Every moment that our patients cannot pay for their medicines or access lifesaving medical care, they are placing their lives and the lives of their families at risk and experiencing worsening health outcomes.

Making medicines and health care affordable is not a theoretical policy discussion. While it is critical to address the nuances of implementing policies that most effectively and sustainably improve health, we cannot afford to get stuck in a political gridlock that stops us from ensuring our patients have access to the medicines and care they need. Our actions or lack of action have real consequences to the health of our patients and communities, and we must act now to address the health of our nation.

Our democracy was formed by the people, for the people, and our government must now listen to us and our communities to directly tackle our nation’s health care needs. We must hold our members of Congress and the administration accountable and provide the support necessary to finally enact legislation that will provide our patients and communities with the affordable medicines and care they need to achieve optimal health, raise healthy families, and strengthen our communities and nation.

To truly address the needs of our patients and place our nation on a path to achieve health equity, as physicians, I urge you to call your members of Congress and express the importance of drafting and passing legislation that will best support the health of our patients and communities.

Click here for the contact information for your members of Congress.

Summary of health provisions to request your members of Congress to include in forthcoming legislation:

allowing Medicare to negotiate prescription drug prices, similar to how the VA already allows drug price negotiation;
capping the cost of insulin to $35 per month, regardless of patients’ insurance status;
expanding Medicaid in states that have not adopted Medicaid expansion;
permanently extending the American Rescue Plan’s Affordable Care Act marketplace health insurance premium subsidies beyond 2022;
capping out-of-pocket costs in Medicare;
extending postpartum care in Medicaid to 12 months;
providing hearing, vision and dental coverage in Medicare; and
ensuring 12 weeks of paid family and medical leave.

Editor’s note: Kuwahara serves as the vice chair of the American Medical Women’s Association’s National Policy and Advocacy Committee and vice chair of Doctors for America’s Access to Affordable Care Impact Area, advocating for prescription drug affordability and access to care, but the views expressed in this piece are entirely her own.