Drug deductibles prevent people from taking the drugs they need
A bill just passed in the state Senate could change the lives of nearly 2 million Californians with chronic illnesses.
Moved by Physician and Senator Richard Pan, D-Sacramento, Senate Bill 568 would require state-regulated, high-deductible health plans to provide “first dollar coverage” for chronic disease preventive drugs and diabetes supplies.
Currently, patients have to pay for these drugs out of pocket, until they reach an annual deductible limit. Under the bill – currently before the assembly – insurers could not charge deductibles for drugs.
This change would have a huge impact on patients who need constant medication to manage long-term conditions like heart disease, high blood pressure, and diabetes. Not only could the bill save them thousands of dollars a year while improving their health, it could also save the health care system millions of dollars by improving adherence.
Not taking prescribed medications, which is called “non-adherence”, has serious consequences. According to a Kaiser Family Foundation survey, nearly a third of people who deviated from their doctor’s orders ended up seeing their condition worsen rather than improve. One study found that up to 125,000 Americans die each year due to non-compliance.
The problem is magnified for people with chronic illnesses who must make health care decisions day in and day out. Over 60% of Americans have at least one chronic disease and 42% have two or more. For these patients, charging large deductibles before covering drug costs can be particularly distressing.
Consider two patients whose plans require $ 2,000 in personal expenses before the insurance company foots the bill.
One is a healthy youngster who spends a hundred dollars a year on drugs, perhaps antibiotics, to treat a short-lived infection or injury. She may have to pay for the drugs out of pocket, but with purchases spread throughout the year, the cost is manageable.
A chronically ill patient, on the other hand, can easily spend $ 1,000 in January alone, while still being only halfway through the deductible limit. This significant financial burden could lead him to ration his prescriptions or to leave the drug completely at the pharmacy.
Half of people with chronic illnesses report non-compliance, with many citing high costs as the cause of driving. A quarter of diabetic patients have rationed the insulin they need to stay alive.
When patients are unable to take their medications as directed, they may end up requiring additional treatment, costing them and the health care system dearly. Nationally, problems caused by non-adherence account for 10% of hospital visits and cost nearly $ 300 billion in a typical year.
The drug adherence crisis cannot be solved with a single state law, but Pan’s bill is a step in the right direction and could serve as a national example.
We know that the rule change he is proposing is feasible because it would build on the protections that already exist for other medical coverages. Under the Affordable Care Act, insurance companies must provide first dollar coverage for preventive care, covering blood pressure tests and routine vaccinations before patients reach their deductibles.
The important reality is that in the long run, insurers could save money through better adherence and better health outcomes for patients.
Reimbursable expenses are a major barrier to medical care. Requiring first dollar coverage for preventive treatment for chronic disease can help make health care affordable.
Kenneth E. Thorpe is Professor of Health Policy at Emory University and Chair of the Partnership to Fight Chronic Disease.