Ellen Nash, 20, a college sophomore, had been taking a generic asthma drug for a year, with a copay of just $5, when her doctor decided to switch her to a newer drug. He wanted to put Nash on the different drug—for which there is no generic—to lower her chances of an asthma emergency.
But when Nash went to pick up her prescription at the pharmacy she found that even with insurance, her out-of-pocket cost for the medicine would be $45 a month—$540 per year—about half her annual income from babysitting over the summer. She decided to ask her doctor to put her back on the generic. That decision increased Nash's risk for an asthma attack, and it also made her part of a group of Americans who are spending less on medication—sometimes at their peril.
A new study published this week found that consumer spending on drugs fell last year for the first time in six decades. In specific, the amount we paid for our medications dropped by 3.5 percent in 2012, according to a report from IMS Institute for Healthcare Informatics called Declining Medicine Use and Costs: For Better or Worse? The research found that spending on drugs in the U.S. last year totaled $325.8 billion, and per capita we spent $898, down $33 from 2011.
Why the drop? There are several reasons, including fewer patient visits to doctor's offices, fewer non-emergency admissions to hospitals and outpatient facilities, and a less severe flu season in the early part of 2012—all of which translated into fewer drugs bought at the pharmacy.
In addition, many expensive brand-name drugs saw their patents expire in 2012, which accounted for $28.9 billion of the drop in medication spending, according to the report. What that means for the average person is that most Americans saw their drug co-pays decline if they were switched to a generic drug from a brand-name version. For example, the asthma drug Singulair went off-patent last year, dropping the per-month cost for patients from about $100 for people without insurance to about $30; people with health insurance saw a dip from $10 to $5 for their co-pay because of the lower cost insurers charge their members for generics. The report found that patients filled 72 percent of all pharmacy prescriptions with a co-pay of $10 or less.
While less spending is usually a good thing, report analysts are troubled by the fact that some people are simply spending less because they're not going to the doctor or hospital when they need to. “To some extent, this is a harbinger of more efficient use of our healthcare resources, but it also reflects a decline in utilization that may be the result of under-treatment and an imbalance between prevention and care,” said Murray Aitken, executive director, IMS Institute for Healthcare Informatics , in a statement released by IMS. (The IMS report was fully funded by the Institute and received no industry money.)
Health experts focused on prevention are, of course, hoping that insurance coverage under the Affordable Care Act (ACA) will mean that many more people can afford visits to the doctor—and can afford to fill the medications that these physicians prescribe. Under the ACA, young adults can stay on their parents’ health insurance, if available, through age 26 and Obamacare should offer health insurance options for younger adults that are more affordable than options available to them now, largely through tax credits.
Have you skipped medication, cut back, or changed to a generic drug because you couldn't afford it?
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Fran Kritz is a freelance writer specializing in health and health policy and lives in Silver Spring, Maryland. Takepart.com