Opinion: The US can’t afford to ignore the high cost of life-saving medications

For many Americans, their confidence in the future of U.S. healthcare is low and their insecurity due to the cost of medicine is high.

In 2001 the Institute of Medicine’s Quality of Health Care in America published “ Crossing the Quality Chasm: A New Health System for the 21 ^st Century,” in which it outlined six goals of safe, effective, patient-centered, timely, efficient and equitable healthcare. In the time since, there has been minimal progress in lowering the price of life-altering medicines.

Now, President Biden and Vice President Kamala Harris have announced a new, landmark deal to lower the price of prescription medications through Medicare, with Biden declaring, “We finally beat Big Pharma.”

This is an important stepping stone for public health, as non-government or private health insurance companies usually follow Medicare’s lead.

Republican presidential candidate Donald Trump similarly has made promises on reducing drug prices, stating, “Under my policy, the United States government will tell Big Pharma that we will only pay the best price they offer to foreign nations, who have been taking advantage for so long — the United States is tired of getting ripped off.”

While U.S. campaigns for presidential elections are polarizing — particularly this year — making healthcare more affordable should not be unique to one party.

In the U.S., medication expenses grew 7.7 percent from 2020 to 2021, totaling $576.9 billion. In 2023, it increased another 13.6 percent, totaling $722.5 billion.

One example is semaglutide, more commonly known as the two branded weight-loss drugs Ozempic and Wegovy. These were among the top medications in 2023 , in large part because more than two in five U.S. adults suffer from obesity, which often comes with other serious chronic diseases like heart disease and diabetes.

When individuals facing obesity-related health problems are inundated by pharmaceutical ads, articles and success stories about weight loss from semaglutides, they may ask themselves, “How can I get this medication for myself?” But the cost depends on insurance coverage and a person’s ability to pay the remaining out-of-pocket cost-sharing price. For those without insurance, the cost is entirely theirs to bear.

Without insurance, semaglutide is available from pharmacies for $915 per injection dose or $1,350 for a 28-day supply of four injection doses. Most insurance companies only cover semaglutide for Type 2 diabetes; coverage is limited or unavailable for weight loss. With insurance or a manufacturers discount, semaglutide can cost as little as $25 per month .

The high cost of medications in this country is not a new issue.

Insulin was discovered and produced artificially over 100 years ago. However, it has not been affordable.

One longitudinal study looking at trends in the price of insulin products between 2012 and 2019 found that the price of both long-acting and short-acting insulin products increased at an average annual rate of about 12 percent. Another study looking at a 10-year trend of insulin and other glucose-lowering medications found that, despite stable insulin use between 2009 and 2018, total insulin expenditure still “almost doubled per person per year…regardless of insurance status.” For the uninsured population, the out-of-pocket cost of insulin increased from $1,678 per person per year to $2,800.

This is too high a cost for patients to bear, and it’s not worth the cost of chronic diseases such as obesity and diabetes.

Obesity is a risk factor for Type 2 diabetes, heart disease and some cancers. It affects 20 percent of children and 42 percent of adults, and it costs the U.S. healthcare system almost $173 billion a year . Today, more than 38 million people in the U.S. have been diagnosed with diabetes, which can cause additional complications such as kidney failure and blindness. As the Centers for Disease Control and Prevention states, diabetes carried a total estimated cost of $413 billion in 2022.

Policymakers across party lines and in the industry need to focus their efforts reducing the price of medications and improving the transparency of the pricing process. Manufacturer rebates or discounts are not enough to combat rising U.S. healthcare costs. Lowering the cost of healthcare should be on every policymaker’s agenda.

Grace Han, DNP, APRN, is a certified family nurse practitioner at Massachusetts General Hospital and a Public Voices Fellow with The OpEd Project.

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