The COVID-19 pandemic is ravaging the nation and taking a disproportionate toll on African-American and Hispanic communities. Yet the Centers for Medicare and Medicaid Services just moved ahead with a rule that will make it more difficult for vulnerable Americans to access the medicines they need.
The new CMS rule increases prescription costs for patients by enabling insurers to ignore cost savings — available through manufacturer coupons — when calculating out-of-pocket spending at the pharmacy.
It’s imperative to remove barriers to treatment and adherence that prevent patients and their families from living healthily. This rule achieves the opposite.
Nationwide, the COVID-19 infection rate in predominantly African-American counties is more than three times that in predominantly white counties. And residents of predominantly African-American counties are six times more likely to die from COVID-19 than those of predominantly white counties.
Many Americans have reduced their risk of COVID-19 infection by working from home. While the U.S. Bureau of Labor Statistics found that’s an option for 30% of white Americans, the same is true for only 20% of African-Americans and 16% of Hispanic Americans. As a result, members of these demographics face more frequent exposure to the virus.
Underlying health factors also exacerbate risk for these communities. A significant cause of the higher COVID-19 mortality rates can be attributed to higher rates of chronic conditions. Some 47% of African American men suffer from heart disease, compared to 37% of white men. Meanwhile, Hispanic Americans are 50% more likely to succumb to complications from diabetes, compared to white Americans, and to be challenged by poorly controlled blood pressure and obesity.
African Americans and Hispanic Americans also have lower incomes, on average, than white Americans. The median net worth of white households in the United States was nearly 10 times that of African American households and eight times that of Hispanic American households in 2016. Too often, high out-of-pocket costs prevent adherence to their necessary prescription drug regimens.
Last year, nearly one in three Americans skipped doses of their medicines because of cost concerns. Such nonadherence is particularly prevalent among those with chronic conditions. All told, nonadherence causes 10% of hospitalizations and results in 125,000 deaths each year.
At a moment when members of communities of color are worried about their well-being and personal finances, the CMS’ actions will further compromise the physical and financial health of these individuals and their families.
Prescription drugs can be expensive, even for those with insurance. To reduce a patient’s burden, drug manufacturers offer coupons to offset costs at the pharmacy. All told, coupons saved patients $13 billion in 2018 alone. Today, most insurers count the value of coupons toward enrollees’ deductibles and out-of-pocket maximums. If, for instance, a patient needs a specialty drug that’s sold by her local pharmacy for $220 — but has qualified for a $200 coupon from the manufacturer — she’ll only pay $20. But the full $220 received by the pharmacy would count toward her out-of-pocket spending.
The new rule will allow insurers to exclude the value of these coupons when calculating patients’ out-of-pocket spending. This will cause pharmacy spending to skyrocket for patients, thus driving many to skip the medicines they need.
COVID-19 is taking a toll, especially in minority communities. These patients need medications to manage their conditions and stay healthy, especially now. This new rule takes us backwards.
Gary A. Puckrein is president and chief executive officer of the National Minority Quality Forum.