{"id":35413,"date":"2024-11-20T07:00:28","date_gmt":"2024-11-20T07:00:28","guid":{"rendered":"https:\/\/updates-www.mccdn.io\/vitals\/?p=35413"},"modified":"2025-05-13T22:55:22","modified_gmt":"2025-05-13T22:55:22","slug":"high-cost-medications-barrier-to-care-for-many","status":"publish","type":"post","link":"https:\/\/updates-www.mccdn.io\/vitals\/high-cost-medications-barrier-to-care-for-many\/","title":{"rendered":"High-cost medications: Barrier to care for many","gt_translate_keys":[{"key":"rendered","format":"text"}]},"content":{"rendered":"

At MultiCare, we are committed to working toward health equity \u2014 ensuring all people have access to quality health care regardless of age, race, ethnicity, gender identity, religion, sexual orientation, ability, socioeconomic status or location. But we also recognize the reality that longstanding biases and barriers embedded in the health care system, and our society, can prevent people from accessing the care they need.<\/em><\/p>\n

In this series \u2014 inspired in part by our awareness that not everyone has the same chance to be healthy \u2014 we take a deeper look at the disparities that impact our patients and how we as health care providers and community members can improve the health and well-being of all.<\/em><\/p>\n

A life-changing diagnosis often comes with high medication costs<\/strong><\/h2>\n

After a life-changing diagnosis, it may feel as though everything has been flipped upside down. There are important decisions to make about treatment and how to balance it with family and work.<\/p>\n

Your recovery will likely come down to finding the right medication.<\/p>\n

The last thing you want to hear is that the medication you need could cost you thousands of dollars a month. For many people, that is the harsh reality.<\/p>\n

\u201cWhen it\u2019s a life-threatening diagnosis, patients don\u2019t need to add financial and insurance worries on top of it,\u201d explains Melissa Gallegos, MultiCare specialty pharmacy manager. \u201cMany patients probably don\u2019t know how expensive medications can be unless they\u2019ve seen it firsthand. It can be extremely frustrating if you don\u2019t have the right support and services.\u201d<\/p>\n

At MultiCare, our social workers, patient financial navigators and providers help connect patients to various financial assistance programs available to cover costs, Gallegos says. But even for them, it\u2019s a complicated and ever-changing environment.<\/p>\n

Why are some medications so expensive?<\/strong><\/h2>\n

You\u2019ve likely bought more affordable over-the-counter medications, especially if you don\u2019t have a chronic condition that requires regular prescription medications. Depending on your insurance and prescription coverage, many medications can still be relatively affordable.<\/p>\n

In the past decade, though, these prices have been increasing. Humira, for example \u2014 which is commonly prescribed to treat moderate to severe rheumatoid arthritis, plaque psoriasis and Crohn\u2019s disease \u2014 previously cost about $2,000 a month, Gallegos says. Now, it\u2019s about $6,000.<\/p>\n

Many health conditions also require more than one medication.<\/p>\n

\u201cMost people in heart failure have a general cardiologist, a primary care provider and a provider who monitors their pacemaker, and each of these providers may prescribe medications with a high copay. These add up,\u201d explains Jennifer Bayne, MSW, LICSW, medical social worker at MultiCare\u2019s Pulse Heart Institute Heart Failure Services. \u201cSo, you\u2019ll have five to six medications that are $80-$100 copays each.\u201d<\/p>\n

Or, if you have multiple conditions that each require a prescription, those costs quickly add up, too.<\/p>\n

As patients move into the specialty pharmacy realm, which provides access to medications for more complex conditions like multiple sclerosis or cancer, the costs skyrocket in part because of the work that goes into creating these treatments.<\/p>\n

\u201cWhat happens when people have to go off their medications for whatever reason, like losing insurance? We\u2019re working against the clock a lot of the time.\u201d<\/p><\/blockquote>\n

\u201cThese medications often treat very small patient populations, and because of that, the cost of research and development is spread out over a much smaller population,\u201d she says. \u201cThat\u2019s partly how high prices are justified.\u201d<\/p>\n

This research and development is crucial, though, Gallegos adds. There are new, more effective therapies available, and sometimes even cures for conditions we didn\u2019t previously have.<\/p>\n

Strensiq, for example, is the first and only treatment for people with perinatal\/infantile \u2014 and juvenile \u2014 onset hypophosphatasia (HPP), which is a rare, inherited disease that can lead to soft, weak and deformed bones and have long-term impacts on development and mobility. The cost of this treatment can reach $100,000 a month, Gallegos says.<\/p>\n

Who is most impacted by high medication costs?\u00a0<\/strong><\/h2>\n

Unfortunately, anyone could face a diagnosis that requires expensive care at any point in life. At the Heart Failure Clinic, you may expect patients to be older, but Bayne says it\u2019s getting more common to see people in their 20s and 30s.<\/p>\n

\u201cWe have a lot of young moms who had complications during pregnancy and develop heart failure,\u201d Bayne says. \u201cWe have other people whose bodies may have tolerated their heart condition for years because of their healthy lifestyle and it suddenly shows up later.\u201d<\/p>\n

Heart failure is a lifelong, progressive disease, and many of the procedures patients undergo require long-term medications afterward, she explains.<\/p>\n

\u201cWhat happens when people have to go off their medications for whatever reason, like losing insurance?\u201d says Bayne. \u201cWe\u2019re working against the clock a lot of the time.\u201d<\/p>\n

Your out-of-pocket costs largely depend on your insurance status, she explains. Someone could be uninsured for several reasons, including not qualifying for state or federal programs, not having employer-offered insurance, or not being eligible for coverage due to immigration status \u2014 although that is slowly improving.<\/p>\n

Those enrolled in commercial insurance, whether through an employer or elsewhere, may still face high copays. Medicaid can be a helpful resource to cover costs if you qualify (in Washington state, a single adult with income less than $1,732 a month qualifies for Medicaid).<\/p>\n

Medicare \u2014 for those ages 65 and older, or younger individuals with certain disabilities \u2014 can help alleviate some of the burden, says Bayne. But depending on how robust your Medicare plan is, you may still have very high copays, which can be challenging for people living on very tight budgets.<\/p>\n

The Heart Failure Clinic averages about 100 new patients per month, she says. Of those, at least one a day is struggling to pay for medication.\u00a0<\/strong><\/p>\n

What support is available?<\/strong><\/h2>\n

Patients have several options for financial assistance, including drug manufacturer copay cards, grants\/foundations or patient assistance programs that can help cover costs, Gallegos explains.<\/p>\n

Eligibility for assistance may depend on your current plan or income, or which state you live in, adds Michael Lee, MultiCare managed care pharmacist.<\/p>\n

\u201cWe have to train every staff person to know how to get people help,\u201d Bayne says.<\/p>\n

The sooner patients get the process started, the better the outcome and assurance that there\u2019s no lapse in treatment, she adds.<\/p>\n","protected":false,"gt_translate_keys":[{"key":"rendered","format":"html"}]},"excerpt":{"rendered":"

At MultiCare, we are committed to working toward health equity \u2014 ensuring all people have access to quality health care regardless of age, race, ethnicity, gender identity, religion, sexual orientation, ability, socioeconomic status or location. But we also recognize the reality that longstanding biases and barriers embedded in the health care system, and our society, […]<\/p>\n","protected":false,"gt_translate_keys":[{"key":"rendered","format":"html"}]},"author":115,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[43,155,63,99],"tags":[],"class_list":["post-35413","post","type-post","status-publish","format-standard","hentry","category-cancer","category-health-equity","category-heart-health","category-primary-care"],"acf":[],"yoast_head":"\nBarrier to care: High-cost medications- MultiCare Vitals<\/title>\n<meta name=\"description\" content=\"A life-changing diagnosis often comes with expensive medication and treatment, but the good news is that there are options for assistance.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" 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