Prescription drug affordability woes grow for Americans

May 18 2005

More Americans—especially those with chronic conditions such as diabetes, asthma and depression-are going without prescription drugs because of cost concerns, according to a new national study by the Center for Studying Health System Change (HSC).

Among all American adults, prescription drug access problems rose markedly for adults with chronic conditions, increasing from 16.5 percent in 2001 to 18.3 percent in 2003. As a result, more than 14 million American adults with chronic conditions—more than half with incomes below 200 percent of the federal poverty level, or $36,800 for a family of four in 2003—could not afford all of their prescriptions in 2003.

"Adults with chronic conditions were twice as likely as other adults to have problems affording prescription drugs," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

The study's findings are based on HSC's Community Tracking Study Household Survey, a nationally representative survey that asked people about their ability to afford prescription medicines. In 2003, the survey included 36,500 adults 18 and older, while the 2001 survey included responses from 46,400 adults.

The proportion of all American adults reporting problems affording prescription drugs also ticked up between 2001 and 2003, increasing from 12 percent to 12.8 percent. This small but statistically significant increase in affordability problems likely resulted from higher prescribing rates and increased patient cost sharing, according to the study.

In another indication that increased patient cost sharing contributes to prescription affordability problems, the proportion of privately insured, working-age people with chronic conditions who reported not filling at least one prescription because of cost concerns increased from 12.7 percent to 15.2 percent between 2001 and 2003.

"As medical needs for prescription drugs continue to grow, it's likely that the proportion of working-age Americans, especially those with chronic conditions, going without prescription drugs because of cost concerns will continue to grow," said Marie Reed, M.H.S., an HSC health research analyst and study author.

The study's findings are detailed in a new HSC Issue Brief—An Update on Americans' Access to Prescription Drugs. Other key findings include:

• Low-income, uninsured working-age adults with chronic conditions were most likely to have cost-related access problems, with nearly 60 percent reporting they could not afford all their prescriptions in 2003. Nearly 40 percent of chronically ill low-income people with public insurance, such as Medicaid, were unable to fill at least one prescription because of cost concerns. And, in 2003, the rate of access problems for low-income, privately insured working-age adults with chronic conditions was similar to that faced by those with public insurance-nearly 35 percent had cost-related unmet prescription drug needs. Among low-income elderly Medicare beneficiaries with chronic conditions, 17 percent reported being unable to fill at least one prescription.
• Elderly Medicare beneficiaries living with chronic conditions who had private supplemental coverage-employer-sponsored or Medigap-were not more likely to report problems affording their prescription in 2003 than in 2001. But prescription drug access problems did increase for beneficiaries lacking supplemental private coverage, growing from 12.4 percent in 2001 to 16.4 percent in 2003.
• Regardless of insurance coverage, about half of low-income working-age adults with chronic conditions and an unmet prescription drug need paid more than 5 percent of their incomes for medical expenses in 2003. And more than half of these-nearly 1.8 million working-age adults-paid more than 10 percent of their incomes for medical expenses and still were unable to purchase all of their prescriptions. These estimates are conservative since payments for insurance premiums were not included as out-of-pocket medical expenses.
• Privately insured working-age blacks with chronic conditions were nearly twice as likely as whites to not be able to afford all of their prescriptions-22 percent vs. 13 percent-in 2003. Similarly, 17 percent of black elderly Medicare beneficiaries reported problems affording prescription drugs compared with 9 percent of white beneficiaries.