Yesterday, the CDC released a data briefing with statistics about strategies used by adults to reduce prescription drug costs. The report found that the strategies were most commonly practiced among the uninsured compared with those with private insurance or Medicaid, as 39.5% asked their doctor for a lower-cost medication, 33.6% did not take their medication as prescribed, and 13.9% used alternative therapies. Not taking medication as prescribed, including skipping doses and taking lower doses, is a dangerous and potentially life-threatening practice that many of our free clinic patients have been forced to adopt out of necessity due to high prescription drug prices.
High prescription drug prices were the topic of a Senate Finance Committee Hearing just last month, which NAFC’s CEO Nicole Lamoureux attended. Last week, we submitted testimony to the Senate on this topic.
The full text of our testimony can be found below.
STATEMENT FOR THE HEARING RECORD
SENATE FINANCE COMMITTEE HEARING
DRUG PRICING IN AMERICA: A PRESCRIPTION FOR CHANGE, PART II
FEBRUARY 26, 2019
NICOLE LAMOUREUX, PRESIDENT and CHIEF EXECUTIVE OFFICER
NATIONAL ASSOCIATION OF FREE AND CHARITABLE CLINICS
1800 DIAGONAL ROAD, SUITE 600, ALEXANDRIA, VA 22314
Chairman Grassley, Ranking Member Wyden and Members of the Committee, my name is Nicole Lamoureux and I am the President and Chief Executive Officer of the National Association of Free and Charitable Clinics. Last month, I was sitting in the hearing room as the pharma executives testified. While I applaud Congress for finally getting these executives to speak, I noticed some important gaps in the conversation.
During the hearing, both Congress and the pharmaceutical executives focused on a specific group of Americans: those with health insurance. Senate Finance Committee Chairman Grassley opened the hearing by describing how high list prices hurt “those with high deductibles” and “taxpayers,” but did not mention the uninsured. While we understand that the committee’s focus remains largely on health programs within your jurisdiction that require significant federal investments, we believe that by not addressing the high cost of medication for the uninsured as well as the insured, the overall cost of health care will continue to increase.
When medication costs are too high, uninsured individuals must forgo their medication or split doses, and often end up needing the emergency department for both the repercussions of missed prescriptions and for primary care. Research shows that 75 percent of all emergency department visits not resulting in admission are for non-emergencies that should be treated outside of the emergency room (Hwang et al. 2012). Patients who lack insurance and access to primary care are often forced to use the emergency room for routine medical needs. These emergency room visits are expensive, contribute to overcrowding, and drive up healthcare costs for everyone.
Currently, there are 27 million Americans without insurance— about 1 in 12 people— and that number is growing. I know this group well. These are the people who receive access to health care and medication from the 1,400 free and charitable clinics in our country. Free and Charitable Clinics are safety-net health care organizations that utilize a volunteer/staff model to provide a range of medical, dental, pharmacy, vision and/or behavioral health services to economically disadvantaged individuals. Such clinics are 501(c)(3) tax-exempt organizations or operate as a program component or affiliate of a 501(c)(3) organization. Free or Charitable Clinics restrict eligibility for their services to individuals who are uninsured, underinsured and/or have limited or no access to primary, specialty or prescription health care. Additionally, Free and Charitable Clinics receive little to no state funding and no federal funding, do not receive HRSA 330 funds, and are not Federally Qualified Health Centers or Rural Health Centers. Therefore, these clinics rely heavily on the generosity of individual donors, foundations and grants as funding sources.
Even though our organizations do not receive federal funding, we are impacted by every decision that is made at the federal level, especially when it comes to medication affordability. In 2018, the 1,400 free and charitable clinics served 2 million Americans, with a total of 6.3 million patient visits. In the most recent data reported by our members, the number one concern for both our patient population and their providers is the high cost of medication.
I understand why Medicaid and Medicare patients were the main focus of the testimony, but the needs of millions of uninsured Americans are also critical to the conversation about solving the pricing issues and inequities of the current healthcare system. When Congress asked the seven executives, “Who pays list price?” Merck CEO Ken Frazier responded by saying, “There’s a small percentage of people who have no insurance who could actually be charged the list price.” He also said that in our current system, “The poorest and the sickest are subsidizing others.” Senator Daines summarized the issue this way: “So the people who can afford it the least, arguably, are paying the list price?”
Those who are paying the list price are our patients, the uninsured and underinsured in this country. The current minimum price of $150 for a vial of insulin is not affordable for a mother making the choice between putting food on her table or paying for her prescription. Our patients have no choice but to ration medications, taking lower doses of them or stopping them altogether. We have no shortage of these stories, from young adults eating less than they should to reduce the amount of insulin they need to parents starving themselves to afford insulin for their children. In our network of clinics, this is a lived reality.
In a time when few issues are truly bipartisan, and health care continues to become ever more divisive, the exponential growth of drug prices is a rare issue that crosses the aisle. Needing insulin isn’t red or blue, nor is using an EpiPen or depending on an inhaler to breathe. We need to harness this rare moment of unity and push for true progress.
I know that Congress realizes how important it is to have the conversation to make medication more affordable once and for all, so we can fix this broken system. I want to make sure we get it right this time around. America’s free and charitable clinics try to catch the people who slip through the cracks. If we don’t stop this unchecked rise in the cost of medications, these cracks will widen until they threaten the foundation of our health care system.
I appreciate the opportunity to submit my comments to the hearing record on behalf of the 2 million Americans who receive care at free and charitable clinics and look forward to answering any questions that the committee might have.
Hwang, Liao, Griffin, and Foley Do Free Clinics Reduce Unnecessary Emergency Department Visits? The Virginian Experience Journal of Health Care for the Poor and Underserved 23 (2012): 1189–1204