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The High Cost of Unaffordable Health Care

We have talked a lot about drug prices, the PBM market, and the policies that have led to our current health care situation. But it is also important to realize that behind the abstract debates and numbers, these policies affect tens of millions of people. And our current unregulated PBM market and high prescription drug prices have substantial costs that are often borne by those who can least afford them.

NBC News recently ran a report on Gabriella Corley, a fourth grader in West Virginia who has type 1 diabetes and is allergic to the kind of insulin that her insurance company covers. If she does not take insulin daily, she could slip into a coma or even die. Gabriella needs Apidra, a special kind of insulin, just to stay alive, but the insurance her family has only covers 25% of the price. As a result her mother has to pay hundreds of dollars a month to keep her daughter alive, and has to trade for insulin online from other families, leave bills unpaid, and sometimes go without food or electricity.

Apidra’s price has increased by 1,123% since 1996, and when Gabriella’s doctor wrote to the insurance company and requested a lower copay for the medicine, they were denied. The drug manufacturer, health insurer, and pharmacy benefits manager were all asked about this tragedy. All three companies defended their own policies, blamed the other actors for high costs, and offered the Corley family no meaningful help. Stories like this are not isolated incidents, and insurers often change what insulin or drugs they will cover, forcing patients to pay more or frantically search for alternatives.

This state of affairs does not happen in other industrialized countries—Americans pay the highest prices for prescription drugs in the world. We need regulation and strong enforcement of laws to protect consumers and ensure an equitable health care system that provides people with the care they need. That is why we are fighting for reduced drug prices, regulation and transparency of PBMs, and increased consumer choice.

Over the past few years, we have also become aware of something: people crowdsourcing their health care on the Internet. In far too many cases, people cannot afford to pay their medical bills or the costs of their prescription drugs, and so they turn online and plead with friends, colleagues, and onlookers to help them get the medical care they need. Frequently communities respond with incredible generosity and literally save lives. But this is not a sustainable system, and for every individual who does manage to crowdsource their health care, there are many others who do not.

If there were robust laws to ensure Americans had access to affordable prescription medicines and that PBMs, health insurers, and drug manufacturers competed vigorously and served consumers, people would not have to beg for money to afford health care. And Gabriella and her family would be able to get the insulin they need without almost bankrupting themselves and resorting to the black market.

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