Access to affordable medications is a critical issue in the United States. As many as 18 million Americans reported being unable to afford needed prescriptions. When people struggle with the cost of medications, this barrier can have a significant impact on their health and well-being.
There are a number of major factors that can make it difficult to afford medications. Some of the most common include:
- High prices: The cost of medications has been rising steadily in recent years. Overall pharmaceutical expenditures in the US were up 4.9% in 2020 over the previous year, and prescription drugs are increasing faster than inflation in many cases. Higher costs make it harder for many to afford medications. A study out of New York City found that 25% of people faced some financial barrier to getting the care they need. This has real consequences. One study found that when people missed or delayed medication for cost-related reasons, they had significantly higher mortality rates specific to their disease.
- Insurance coverage: Not everyone has insurance coverage–5 million Americans were uninsured in 2021. Even among those with insurance, more than ever have high deductible plans, more than half, according to one survey.
- Out-of-pocket costs: Even if insurance covers medications, individuals may still have to pay a portion of the cost out of pocket. The Commonwealth Fund found that in 2020, one fifth of older Americans paid more than $2,000 in out-of-pocket medical costs, and many skipped care because of those costs. In the state of Utah, it was found that even a $2 copay imposed on Medicaid members reduced their use of prescription drugs. What seems like a small burden to some can be a barrier to others, especially if they need multiple medications.
- Cuts to government programs: On May 11, 2023, the Public Health Emergency (PHE) declaration instituted at the beginning of the COVID-19 pandemic ended. The PHE reduced the number of uninsured people to its lowest rate in history. However, the ending of those regulations will likely cause state cutbacks to Medicaid programs, leaving 18 million people without coverage under the program.
- Health literacy: People with low health literacy may have difficulty understanding the instructions for taking their medications, such as the dosage, frequency, and duration of treatment. They may also struggle to communicate or be hesitant to ask questions. When people understand how to use their prescriptions, or have providers and pharmacists to assist them, medication adherence improves, as shown in a 2019 study of Hispanic adults on hypertension drugs.
Enter independent pharmacies. These local, specialized businesses are uniquely positioned to offer services that can help overcome some of the factors mentioned above. Through things like coordination with insurers, alternative packaging, delivery, synchronized refills and more, independent pharmacies are key to the solution to help providers get individuals medications on time, accurately, and at an affordable price.
Barriers to Access Prescriptions
Medications are an essential part of treatment for many people. Medications can help to treat a wide range of conditions, from common colds to chronic diseases to behavioral health conditions. However, prices and insurance aren’t the only reasons people struggle to get the medications they need. Health and social disadvantages also factor into limited prescription drug access.
People who live in rural areas or who do not have access to reliable transportation may have difficulty getting to a pharmacy to fill their prescriptions.
Other individuals may face a language barrier if they do not speak English as their first language. Without a translator, they may have difficulty communicating with their healthcare providers or understanding how to use prescriptions once they get them, contributing to non-adherence.
Based on life, vocational, and educational experiences and history, individuals may struggle to understand and apply education and instructions regarding their medications. This can be embarrassing for many to admit and result in inadvertent misuse of medications due to lack of comprehension.
Other health issues can also be a barrier to access. Those who face behavioral health challenges may have difficulty managing their medications or may be more likely to require additional care or education to take their medications as prescribed. This vulnerable population may also be more likely to struggle with motivation to prioritize adherence and experience decline in all health conditions as a result. Finally, individuals with other chronic conditions may need to take multiple medications long-term, making it even more difficult to afford all of their prescriptions.
Breaking Down the Barriers Together
Independent pharmacies can offer a number of programs and services to help people get the medications they need.
Pharmacy teams can collaborate with providers to find programs that can help individuals pay for their medications. For instance, Altruix has helped people ineligible for traditional copay assistance through the manufacturer successfully apply for and receive over $2.5 million in foundation grants. These grants bring the individual’s responsibility down to $0 up until the full grant amount is reached.
High-touch pharmacies can also work with insurance companies and practitioners to successfully navigate tricky plan-specific prior authorization requirements for medication approvals, which can help people get the prescriptions they need more quickly.
Local pharmacies have their finger on the pulse of community resources and can help connect individuals with transportation resources or other methods of getting to their medical appointments and to their pharmacy. Pharmacies may also provide delivery services or utilize third party partners (USPS, FedEx, UPS, etc) to offer medications delivered at no-charge directly to the individual to overcome this barrier.
Education and Support
A pharmacist is an integral part of the care team and can offer educational resources and counseling to help people understand their medications and how to manage them.
Many independent, local pharmacies go beyond just filling prescriptions and offer comprehensive services that allow them to serve people better. These pharmacies can reconcile each person’s medications to avoid errors like omissions, duplications, dosing errors and drug interactions. Additionally, they can help coordinate care, synchronize refills, work with labs and the insurance team, and even offer a variety of packaging options or injection services for certain individuals.
People Deserve Better
As a specialty and long-term care pharmacy focused on behavioral health, Altruix specializes in finding solutions to make medications more manageable for the most vulnerable populations. We are committed to breaking down these barriers so more people can access and afford their medications. We believe that everyone should have access to the medications they need to live a healthy life. We are committed to working with providers, clinics, long term care facilities, individuals, and payers to make medications more affordable and accessible.
The problems with access to and affordability of medications are complex and challenging. Healthcare providers, pharmacists, insurance companies, and individuals all have a role to play in ensuring that everyone can get the medications they need.
Together, we can make a difference.