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With campaign season at its peak, every day we hear why each candidate should be trusted to address the challenges facing our country. Despite the seemingly constant political coverage and criticism of the Affordable Care Act, there has been a dearth of realistic solutions proposed, especially regarding substantive and timely relief for patients impacted by exorbitant prescription drug costs. According to the Kaiser Family Foundation’s Health tracking poll conducted in September, 77 percent of Americans say prescription drug costs are unreasonable, and this number is up from 72 percent a year ago. Political candidates should be paying more attention to these issues.
The timeliness of this conversation is most critical to the seniors and chronic illness patients who pay anywhere from $4,000 to $12,000 per year in out-of-pocket expenses for their prescriptions so they can have rightful access to lower-cost and effective medications.
There seems to be plenty of news showing the impact of these rising drug costs on the economy, insurance companies, pharmaceutical companies and their executives, but I’ve found it hard to find significant coverage of the impacts they have on actual patients. I know this struggle firsthand, and have myself been confronted with the painful choice of keeping a roof over my head or paying for my prescription medication.
Since being diagnosed with Crohn’s disease (an incurable inflammatory bowel disease) when I was 13 years old, I have endured my share of pain, surgeries, appointments, and inconveniences because of my condition, and often at great cost. And as a single woman trying to survive on one income, I needed full-time employment to access the health insurance that helped me afford my life-changing medication.
Despite these challenges, I proudly bought my first home in 2008, attaining what I thought was financial stability. At the time, I had a job at a government contractor that provided the health benefits I needed.
But in 2012, I lost my job and was faced with a tough choice: paying my mortgage or the cost of treatment for my Crohn’s disease.
Losing my job was devastating, and meant my only option was to go on COBRA — which cost me between $700 and $900 a month—to pay the full cost of the health insurance that had previously been offered by my employer.
The unemployment insurance payments I received certainly helped, but they would cover either my COBRA or my mortgage — nowhere close to both. Faced with the sober truth that I would still need medication regardless of where I lived, I called a realtor within the week to put my house up for a short sale. My house sold, but for only half of what I had paid for it just four years prior.
I found a new job that offered employer-sponsored health insurance by 2013, and currently use a manufacturer discount program that cuts the three-month cost of my biologic medication from $300 to just $5. Though it is extremely helpful now, this discretionary program could be canceled at any time, which would leave me needing to pay over $8,700 per month for my medication.
Though they are amazing and effective, most people don’t know how expensive medications for chronic conditions can be. Recent public scandals around Martin Shkreli and the manufacturers of the EpiPen are an exception, as there are far more pricing issues affecting patients like me that never see the same degree of attention.
In my case, manufacturers are working to make biologic medication more accessible by way of biosimilars, which are similar to generic options of name-brand drugs. The aim of allowing biosimilars to be sold in the U.S. can be compared, in concept, to the “Hatch-Waxman Act” of 1984, which encouraged the manufacturing of generic drugs and established our modern system of government generic drug regulation. Because of the passage of this generic drug act, nearly 8 in 10 prescriptions filled in the United States today are for generic drugs, and that metric is only expected to grow further.
Patients like me are anxiously awaiting the opportunity to access biosimilars as they enter the U.S. market through the ACA’s opened pathway for biosimilars. These drugs, which are just as safe and effective as their more expensive alternatives, have been available for over a decade in Europe and Australia.
Biosimilars won’t cure these life-altering conditions, but they do provide better treatment options—something patients desperately need. Widening access to these safe, effective, and more affordable medications should be a priority for policymakers, and doing so could help patients and the economy alike. My hope is that the candidates who win this election season will finally champion solutions to high drug costs, like biosimilars, to ensure that the next generation of men, women, and children with chronic illnesses won’t face the same tough choices I did.
Carly Medosch is a chronic illness patient advocate who was forced to sell her home in 2012 to cover the cost of treatment for her Crohn’s disease.
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