By Will Matthews, CQ Staff
JANUARY 27, 2009 -- At least 36 million young and working-age Americans in 2007 went without a prescribed medicine because of its cost and more will have trouble as the economy declines, according to a recent report by the Center for Studying Health System Change (HSC).
The group's 2007 Health Tracking Household Survey found that 14 percent of Americans under 65 could not afford to fill at least one prescription in 2007, compared with 10 percent in 2003 and 2001, the first year the question was asked.
Uninsured, working-age adults with at least one chronic disease were the hardest hit, with almost two-thirds saying they had to forgo prescribed drugs in 2007.
"The fact that they have a chronic condition makes it more troubling that they have an access problem," said HSC spokeswoman Alwyn Cassil. "Their use is less likely to be discretionary."
The overall increase was driven by significant changes in the unmet needs of two groups. Unmet needs changed from 26 percent to 35 percent among uninsured adults and from 9 percent to 11 percent among adults with employer-sponsored insurance. Cassil said the 2 percentage point increase among employed, insured adults—which HSC attributed to deteriorating drug coverage in employee plans—had a particularly strong effect on the overall increase, since a large proportion of the adult population is in that group.
According to the report, the difference between 2007 and the earlier surveys "probably stemmed from higher prescribing rates, drug prices that are rising faster than workers' earnings, higher patient cost sharing in private insurance and the introduction of expensive new medicines."
Cassil said the higher prescribing rates likely stemmed from both an increase in the number of available medications and changes in prescription guidelines, such as the 2004 American College of Physicians recommendation that expanded the use of cholesterol-fighting statins.
"If there are more opportunities for people to be prescribed drugs, it creates more opportunity for there to be problems accessing them," Cassil said. "Certainly there are going to be varying degrees of need."
Cassil acknowledged that the survey did not probe respondents about the types of medications they went without.
Children's unmet drug needs are lower than adults', partially because they are prescribed fewer drugs in the first place, but their rate of affordability problems rose from 3 percent to 5 percent.
Working-age adults with Medicare, Medicaid or other state insurance have more trouble affording their medicines than the general population, the report found, but their unmet drug needs did not change significantly between 2003 and 2007. The Medicare prescription drug program (PL 108-173) took effect in 2006, and about 30 percent of working-age Medicare beneficiaries reported drug affordability problems in surveys both before and after. The report noted that "[m]ost working-age adults eligible for Medicare are disabled and often have very high prescription drug needs and low incomes."
The survey was conducted in late 2007 and early 2008, just as the current economic recession was beginning. "The ability of many people to afford prescription drugs is likely to deteriorate as the economy continues to decline," the report said.
Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America (PhRMA), said the growing difficulties were unsurprising given the economic climate, but that drug companies are working to help patients get the drugs they need.
Johnson said PhRMA's Partnership for Prescription Assistance—which helps patients find drug company assistance programs and features talk show host Montel Williams as its national spokesman—has connected more than 5 million people with such programs since April 2005.
The HSC report noted that pharmaceutical manufacturers do offer assistance programs for uninsured and low-income people, but "the programs are limited and enrollment can be complicated."
"Since the economy has been in turmoil, our companies have really stepped up their efforts," Johnson said, citing relaxed eligibility standards and expanded outreach for the assistance campaign. He said PhRMA companies have distributed $13 billion in free medicine.
A report released this month by the Centers for Medicare and Medicaid Services (CMS) found that while rising health costs continue to outpace overall economic growth, prescription drug costs grew more slowly. CMS attributed the trend to the expanded use of generic drugs and discount programs at large retail chains.