Equitable Access to Life-Saving Treatments is Threatened by the Cost of Drugs to Patients

Eduardo SanchezElliott M. Antman, M.D., FAHA; Senior Physician, Brigham and Women’s Hospital; Associate Dean for Clinical and Translational Research, Harvard Medical School; Past President, American Heart Association

As healthcare costs continue rising, escalating spending on pharmaceuticals warrants serious attention from healthcare stakeholders. In 2015, U.S. pharmaceuticals spending reached $309.5 billion, an increase of 8.5 percent from the prior year, and it’s expected to increase to between $370 and $400 billion by 2020.

This spending on both branded and generic drugs has increased to the point of consensus that the healthcare system as a whole cannot afford it. But it’s patients who are paying the steepest price. Treatment advances have given new hope to millions of heart disease and stroke patients, but that hope could be lost if they don’t have affordable access to lifesaving therapies.

In the midst of this news, I’m happy to report that the American Heart Association (AHA) is taking action.

Last week we released a presidential advisory that examines the drug and biologic markets and explores the potential explanations behind rising drug prices. It also establishes principles to guide the AHA as we advocate in support of patients to address rising drug costs.

Multiple, complex factors contribute to rising drug prices, but I’m particularly troubled about the consequences that patients may reap as a result. When patients must pay more for their prescriptions than they can afford, it can reduce medication adherence and lead to negative health outcomes.

A 2012 review found that when patients can’t afford drug costs, medication adherence decreased in 85 percent of the studies reviewed, and adverse health outcomes affected patients in 76 percent of the studies.

According to a 2015 Kaiser Family Foundation Health Tracking Poll, nearly a quarter of respondents said that they or a family member had not filled a prescription or skipped a dose because of cost. The same poll found that 19 percent reported that they or a family member had cut pills in half to lower costs.

This environment could accelerate disparities if low-income and even average-wage families can’t afford their prescriptions. At the same time, demographic shifts could exacerbate challenges. For example, our aging population will likely result in an increasing number of medications for chronic conditions. Economic status could be the basis for whether patients can access innovative therapies.

It’s in patients’ best interests for therapeutic advancements to push forward, so allocating resources for innovation while better understanding the factors that contribute to drug spending across the health care system is critical.

In addition to the advisory’s publication, the AHA is developing a new initiative aimed at eliminating the barriers to care that limit provider and patient access to guideline-directed medical therapies.

  • Phase I will engage key groups and convene stakeholders across the continuum of care, in both the systems and the patient spheres of influence, to build consensus about existing barriers and identify potential solutions for eliminating them.
  • Phase II will test the solutions identified in Phase I, develop best practices, educate professionals and patients on those practices and retest findings in additional markets.

The American Heart Association advocates strongly for equity and affordability. We believe that every person should have an equal opportunity to be healthy. This means that individuals and communities can access the care and resources they need to be healthy, which may vary from person to person. Treatment costs must be transparent, available and understandable, so practitioners and patients can compare prices with anticipated value to make informed treatment decisions.

Social determinants of health, such as race/ethnicity, education, income and residential environment, influence a person’s ability to afford the medicine they need. The AHA is addressing these factors in our research, scientific programming, community initiatives and policy advocacy.

Our Centers for Health Metrics and Evaluation will continue to collect data and evaluate initiatives to measure the impact of proposed strategies to lower clinical barriers to care. Identifying barriers and testing solutions with partners will make the right medicines available, accessible, and affordable to all patients.

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