When Adria Goldman Gross went to the pharmacy counter, she was surprised to see that the copay for one of her medications more than tripled.
What had cost her $11 out of pocket had jumped to $35. Gross found out that she would only be charged $16 if she bypassed her insurance coverage, paid the cash price and used a drug discount coupon through GoodRx.
"These prices are crazy—they have really taken advantage of us," said Gross, a patient advocate and owner of MedWise Insurance Advocacy. "I know people who cut pills in half so they don't use as much. If people can't take their medication, they will wind up in the hospital."
Gross is working with several patients who have run into similar problems. In one case, a patient was paying $50 a month for cancer treatment, and that skyrocketed to $750 a month, she said. Some people will go to extreme lengths, like purchasing drugs from Canada or Mexico, to work around exorbitant prices, Gross said.
While Gross was able to navigate the system and still afford her medication, not all are as fortunate. Rising out-of-pocket prescription prices are one of several obstacles that can unravel treatment plans, which can come at a major cost to individuals and the healthcare system.
Patients' higher cost-sharing burden for medication can prove fatal, a new working paper found. A $10.40 increase in out-of-pocket costs per prescription was associated with a 22.6% drop in consumption and a 32.7% increase in monthly mortality rates, an analysis of more than 358,000 relatively healthy 65-year-old Medicare beneficiaries found.
"When we raise prices, they mess with people's ability to make good decisions about their health," said Ziad Obermeyer, co-author of the study and associate professor of health policy and management at the University of California at Berkeley. "Those decisions lead to more people dying—health costs need to be priced into these cost-sharing policies."
Ed Schoonveld, a principal at consultancy ZS Associates, said he was shocked by the drop in consumption and increase in mortality.
"This is certainly one reason we need to seriously consider the impact of copays," he said.
The researchers focused on beneficiaries who fell into the Medicare Part D coverage gap known as the "donut hole," where patients are responsible for the full cost of their drugs between certain spending thresholds. Legislative changes have incrementally narrowed that gap, which fully closed in 2020.
In an example in the working paper, a Medicare beneficiary paid 25% of the price of their branded drugs until they reached $2,510 in total annual out-of-pocket spending. The patient fell into the donut hole and had to pay for the full cost until they hit $5,726, after which they were responsible for a 5% copay.
Obermeyer was struck by the finding that the highest-risk patients were not filling their medication after prices jumped. Those most vulnerable to a heart attack and stroke cut back more on statins and anti-hypertensives than lower-risk patients—irrespective of socioeconomic status. The riskiest one-third of patients were 280.6% more likely to drop cardiovascular drugs than the bottom two-thirds; there were similar results for those at high risk of diabetic and pulmonary complications.
Rather than cutting back on one or two drugs, there was a big cohort that stopped filling most if not all of their prescriptions as copays went up, Obermeyer said.
"That fact that this was also happening in high-income ZIP codes does fly in the face of the economics and research that found that people who need the prescription the most and can afford it should be the most likely to fill it," he said.
Drug list prices continue to increase every year. As health insurers and employers pay more, they often pass those costs to consumers in the form of higher premiums, deductibles and copayments.
Pharmaceutical manufacturers hiked the list price of a record 832 drugs in January—nearly 200 more than January 2020 and the highest since at least 2014, when GoodRx started tracking the data. All but 10 were branded drugs and 175 of those were specialty drugs, according to the report.