A key provision in Senate Democrats’ budget reconciliation bill that caps out-of-pocket spending on prescription drugs for Medicare beneficiaries at $2,000 a year could be a lifeline for millions of older adults struggling to pay for heart medications
Drug prices are a “profound and challenging” issue for people taking heart medications, said Dr. Khurram Nasir, chief of the division of cardiovascular prevention and wellness at the Houston Methodist Heart and Vascular Center.
Heart disease is the No. 1 killer of Americans, according to the Centers for Disease Control and Prevention. Nearly 700,000 people die from it every year. According to the American Heart Associationnearly half of American adults have some form of heart disease.
Nasir is a co-author a study published in the journal Circulation 2019 which found that 1 in 8 Americans with heart disease cannot afford their heart medications. The study used data from the National Health Survey between 2013 and 2017.
“The cost of drugs is a real problem for millions of high-risk patients with cardiovascular disease,” Nasir said.
Dr. Mark Fendrick, professor of health management and policy at the University of Michigan School of Public Health, agreed that financial strain is especially common for people taking heart medications.
That’s because, Fendrick said, people who take these drugs are often older and retired and tend to have limited incomes. To make matters worse, they often have other chronic conditions that also require treatment and other expensive prescription drugs.
That’s the case for Jackie Trapp of Muskego, Wis., who has a high risk of blood clots because of her multiple myeloma diagnosis. Trapp is part of Patients for Affordable Drugs, a nonprofit that advocates for lower drug costs.
Trapp, 57, takes Xarelto, a blood-thinning drug that, with Medicare, has an out-of-pocket cost of about $90 for a 90-day supply. That would be manageable, he said, if it weren’t for the added cost of his cancer drugs that top $10,000 a year. She qualifies for Medicare because she is unable to work due to her cancer diagnosis.
“I’m probably going to leave my husband sooner than I’d like, but now I’m also afraid of leaving him bankrupt,” said Trapp, who added that she has dipped into her pension to pay for her medication .
Making difficult financial decisions is not uncommon, Fendrick said. “They often have to choose between filling their prescriptions or paying rent or eating healthy or buying gas.”
Dr. Icilma Fergus, a cardiologist at Mount Sinai Hospital who often treats Medicare patients, said patients often struggle to pay for new heart drugs, such as new oral anticoagulants, which are used to prevent strokes, and PCSK9 inhibitors, which are used to lower cholesterol. .
He said about 1 in 10 patients he sees tell him they can’t afford the heart medications they’re prescribed.
In some cases, patients are forced to delay or skip their medications, he said. In other cases, those who can’t afford drugs switch to older, cheaper drugs, which often don’t work as well as newer drugs and can have more serious side effects.
“Patients are frustrated and disappointed,” Fergus said.
The frustration could get worse, especially as inflation in the US continues to rise.
A survey published Thursday of New West Health-Gallup found that 1 in 4 Americans say they are avoiding medical care or buying prescription drugs because of higher prices for everything from gas to groceries. The survey was conducted in June, the same month inflation reached 9.1%, a new 40-year high.
Senate Democrats hope to vote on the reconciliation deal before their August recess next week.
Tricia Neuman, a Medicare expert at the Kaiser Family Foundation, said if the Senate reconciliation deal were signed into law, it would be “significant” for the more than 60 million Americans on Medicare.
“This is a real pocketbook problem for people, and people understand exactly what it means when they go to a pharmacy and are faced with this big drug bill,” he said.
The $2,000 out-of-pocket limit provision, in particular, would be the first major change to Medicare Part D since 2010, Neuman said, when lawmakers included a provision in the Affordable Care Act to close the ” donut hole,” also known as the coverage gap.
“It’s remarkable that the bill that appears to be on the cusp of a Senate vote can finally adopt a policy that lawmakers, presidential candidates and others have been talking about for decades,” he said.
If the deal doesn’t go through, Trapp said she fears her prescription drug costs will continue as she continues to battle her illnesses.
“I’m almost afraid to wait,” she said.