How Do COPD Patients Make Ends Meet?

It's no secret that health care in America is expensive. According to 2015 data from the Centers for Medicare and Medicaid Services, the United States spends $3.2 trillion per year on health care. That places America at the top of the charts globally in terms of health care spending, averaging out to nearly $10,000 per person annually and accounting for nearly 18 percent of the U.S. economy as a whole.

As the third most deadly disease in America today, chronic obstructive pulmonary disease accounts for a significant portion of those costs. As the name implies, this irreversible lung disease is chronic, meaning it's a long-term problem for patients. It's also progressive, meaning that the longer a patient has the disease, the more complicated -- and likely more expensive -- treatment will become. Doctors' visits, prescription drugs and hospitalizations all add up over time and make for an expensive diagnosis.

According to a 2015 study in the journal CHEST, the total burden of COPD in the United States reached $36 billion in 2010. These medical costs were borne by private insurance (18 percent), Medicare (51 percent) and Medicaid (25 percent). Researchers also projected that the total cost burden of COPD will rise to $49 billion by 2020.

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Although COPD is a manageable condition, being able to afford needed treatments can be a problem for some patients. However, the scope of this problem is not entirely clear. Patients with private insurance through an employer may have less difficulty covering the copayment costs of medications for COPD, but that's dependent on the type of coverage, whether it applies to the needed prescriptions and the cost of the medications. The COPD Foundation reports that unlike many other chronic diseases such as diabetes or cancer, COPD doesn't get as much attention among employers, even though it's "the third leading cause of death in the U.S. and 70 percent of the 24 million individuals with COPD are under age 65. COPD is one of the most burdensome disease for employers, but with half of the 24 million not properly diagnosed, the cost burden may be greater than the data reveals."

Among patients who qualify for Medicare benefits, the challenge to make ends meet may be greater. (Medicare is typically available to individuals over the age of 65 and people younger than 65 who meet certain criteria, such as being disabled and having received Social Security Disability Insurance for more than two years.) A June 2017 Kaiser Health News report indicated that one in nine Medicare beneficiaries have a COPD diagnosis, and that "inhalers like Spiriva and Advair," common prescriptions for these patients, "account for billions in Medicare spending each year."

Patients who can't afford their medications are more likely to experience exacerbations, or a worsening of symptoms that could land them in the hospital, an even more expensive proposition. A 2014 study in the journal PLOS One found that over the course of a 2.4-year period (beginning in 2006), 81 percent of COPD patients in the study experienced an exacerbation. "Exacerbations become more frequent and severe as COPD progresses," the authors write. These exacerbations, "particularly the severe forms, can have serious consequences on the patient's quality of life, lung function, and life expectancy, as well as significantly increasing the burden in terms of health services and costs attributable to the disease." The COPD Foundation reports that "40 percent of COPD costs could be avoided by preventing complications and hospitalizations."

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Making Ends Meet

COPD tends to affect older adults more than younger adults, and many of these patients are on fixed incomes, so shelling out for expensive monthly prescriptions could be a challenge. When the choice comes between paying for heating or food versus the prescriptions that help you to breathe, what's a patient to do?

Some are forced to get creative, and if this describes your situation, make sure to speak with your doctor about any and all cost-saving moves you're making. Financial assistance could be available, and it's important to find out if you're eligible for it and to be sure that any changes you make don't adversely impact your health.

Some patients may be eligible for generic versions of prescriptions, which tend to be significantly cheaper than brand name prescriptions. Others may need to work with their doctors to find other ways of controlling costs, either by reducing the dosage of an expensive medication or shifting to a less-expensive alternative. Some drug companies give doctors free samples of certain drugs, and this may be a lifeline for patients in the direst of financial circumstances, but it's not a surefire fix to this growing problem.

Some patients also find they can purchase less-expensive prescription drugs overseas through the internet, but in some cases, this could be illegal and potentially dangerous if counterfeit or contaminated drugs are being sold. The FDA outlaws the importation of drugs that it has not approved for use here, even if they are legal in Canada or another developed country. However, the FDA does offer some exceptions to this rule, noting that importation is legal if the drug "is for use for a serious condition for which effective treatment is not available in the United States," or if "the drug is considered not to represent an unreasonable risk." Patients importing drugs may have to verify in writing that they're for personal use and provide contact information for the doctor overseeing their care.

To protect yourself from illegitimate drugs and vendors, Consumer Reports recommends that patients check whether the online pharmacy is accredited with the National Association of Boards of Pharmacy. And look carefully, because according to a 2011 report issued by the NABP, a mere 3 percent of online drugstores appear to be legitimate. Pharmacies that are approved will likely display a blue, oval seal noting that it's a Verified Internet Pharmacy Practice Site.

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Here at home, some patients who do not have health insurance coverage or prescription benefits may be able to find a cheaper retail price by comparison shopping at different pharmacies. In addition, some pharmaceutical companies offer patient assistance programs that provide free or reduced-cost prescriptions to patients who can't afford needed treatments. NeedyMeds.org, a national nonprofit organization that helps connect consumers with lower-priced or free prescriptions has more information and free resources online to help you find and apply for these programs.

NeedyMeds.org also offers a prescription discount card that can save consumers up to 80 percent off the cash price of some medications and medical supplies.

In any case, speak with your doctor if you're having difficulty affording your medications.

Elaine K. Howley is a freelance Health reporter at U.S. News. An award-winning writer specializing in health, fitness, sports and history, her work has appeared in numerous print and online publications, including AARP.org, espnW, SWIMMER magazine and Atlas Obscura. She's also a world-record holding marathon swimmer with a passion for animals and beer. Contact her via her website: elainekhowley.com.