The Importance Of Affordable Healthcare: Getting To The Heart Of The Matter
Aysha Ahmed, PharmD, is Chief Medical Director, President & Co-Founder of Vasa HealthIV™.
The average monthly cost of insulin in the U.S., including generics, can range from $50 with prescription coverage to over $1,000 without. Largely applicable across many medications, this type of cost disparity underscores the importance of maintaining appropriate health coverage for those who already have it. But as a pharmacist and healthcare professional, I am more concerned about those with inadequate, heavily restricted or no health coverage: the people standing in line at the pharmacy with tears and desperation in eyes that are darting between their medication, their basket of groceries and their children.
If this makes you uncomfortable, it should. A 2019 survey indicated that 22.9% of American adults were having difficulty paying for prescription medications. That’s 58 million people! In the same survey, 34 million people disclosed that they knew someone who died within the past five years due to an inability to afford treatment. A system meant to keep us healthy now ends up charging the ultimate price.
Why is healthcare so expensive in the U.S.?
There are dozens of reasons U.S. healthcare is too expensive to benefit the majority of citizens, but one stands out above the rest: a non-universal for-profit health system, which, to my knowledge exists in only 10 countries. Because of this model, costs are market-driven, and for-profit drug developers, supply and equipment manufacturers, doctors, hospitals, health coverage providers and even pharmacies can set their prices based on supply and demand. This is compounded by the need for increased care for aging populations and chronic and debilitating conditions, all of which are exacerbated by care that is inaccessibly expensive.
Insulin is a good measure of the uphill battle for affordable prescriptions and healthcare. The U.S. House of Representatives added insulin price caps to the Build Back Better Act (BBBA), which has been stalled in the U.S. Senate since 2021. A separate bill, the Affordable Insulin Now Act (AINA)—designed to cap insulin co-pays at $35 per month under Medicare and either $35 or 25% of a private plan’s negotiated price, whichever is less—passed the House in Spring 2022, but it has also stalled in the Senate. Meanwhile, 20 states have introduced their own insulin price caps, ranging from $35 to $100.
Part-time and low-wage staff are the most at-risk for medical treatment insecurity, meaning that when a person encounters a medical need, they can’t afford it. Budgeting to provide healthcare with low deductibles and employer-paid premiums to all employees, regardless of full- or part-time status, is one of the best ways to make a difference because it means no employee must choose between their paycheck and health coverage.
We also have an obligation to be more thoughtful about the coverages we select for our employees. The most common problems I see at the pharmacy stem from restrictive insurance: The employer-sponsored plan doesn’t cover generics or only covers generics, won’t cover a certain tier of medications and then places most medications into that tier, or stops covering certain medications without forewarning patients and their doctors. This happens multiple times per day, leaving patients to wonder, “What’s the point of health coverage if it doesn’t cover my needs?”
Careful selection of overall coverage is also critical. Self-funded plans, for example, are becoming a corporate favorite due to their cost-effectiveness. But these plans have the potential to jeopardize patient financial security by allowing medical providers and hospitals to skirt balance billing laws, even in emergency care situations. What saves a business a few thousand dollars per year could cost individual employees everything, and it happens every day. With this risk—and others like it—in mind, business owners must consider the employee-side implications of our decisions.
Putting employee health first isn’t just about creating affordable access to health care. The business landscape is changing; employees are no longer accepting the bare minimum. A 2021 survey indicated that 19% of respondents had turned down a job due to issues with compensation or benefits, and that number is only going to grow.
Whatever motivates you—recruitment, retention, corporate social responsibility or just taking care of your own—businesses have the power to make healthcare affordable for our employees while they’re waiting for the law to catch up.
Aysha Ahmed, PharmD, is Chief Medical Director, President & Co-Founder of Vasa HealthIV™. Read Aysh