Most Americans are now paying lower out-of-pocket costs for their prescription drugs but seniors are still facing higher costs for the Medicare coverage, according to a report from the IQVIA Institute for Human Data Science.
The newly published “Medicine Spending and Affordability in the U.S.: Understanding Patient Costs for Medicines” combined prescription cost data with household income data to detail prescription cost affordability trends.
The report determined that 90% of all patients pay less than $500 in out-of-pocket costs on an annual basis, although 20% of Medicare Part D patients paid more primarily because they were unable to offset costs through manufacturer coupons and plan design, as well as a greater disease burden and associated higher per capita medicine use by seniors.
Across all age groups, the average out-of-pocket cost for an insulin prescription was $31 in 2019, down from a record high of $35.70 in 2015. The report noted that some patients filling prescriptions for insulin would financially benefit from proposals to set a cap of $35 per prescription.
Although the $67 billion paid out-of-pocket by patients for all prescriptions filled in retail pharmacies in 2019 was a record high, the report stressed this was mainly due to a higher volume of prescriptions, particularly among seniors.
Medicare beneficiaries filling prescriptions under Part D paid more out-of-pocket in total because of the rising numbers of enrollees, with a greater percentage paying more than $500 in annual costs.
The report also pointed out that 9% of all new prescription starts in 2019 were abandoned at retail pharmacy. Although abandonment rates were less than 5% when the prescription carried no out-of-pocket cost, it ballooned to 45% when the cost was over $125 and 60% when the cost was over $500.
For diabetes medication, anticoagulants and oral cancer drugs, the average abandonment rate was 18% of all new therapy starts because most of these drugs had higher costs.
“Lower drug price growth and improvements in affordability to patients is a testament to the positive market dynamics of the American pricing system and the fact that manufacturers, health insurers and the intermediaries, such as wholesalers and benefits managers, have taken actions to reduce the burden of drug costs to patients,” said Murray Aitken, senior vice president at Danbury-based IQVIA and executive director of the IQVIA Institute for Human Data Science.
“The current pricing system is very complex, and understanding the amount spent on medicines requires considering a range of measures that apply to the different stakeholders in the drug chain, including manufacturers, payers, benefits managers, wholesalers and patients. We are hoping that our report will contribute to more transparency and understanding of the different levels of cost.”
