Drew Altman, Kaiser Family
Foundation Jul 29, 2019
A very small
group of patients with major illnesses is responsible for an outsized share of
health care spending, and new data show that prescription drugs are a big part
of the reason their bills are so high.
The big
picture: Among people who get their coverage from a large employer,
just 1.3% of employees were responsible for almost 20% of overall health
spending, averaging a whopping $88,000 per year.
Between the
lines: “Persistently high spenders” are people who have
accumulated big health care bills for at least 3 consecutive years.
- They
often have HIV, MS, cystic fibrosis, rheumatoid arthritis, diabetes,
cancer and other serious conditions requiring frequent and often costly
care.
- Drugs
are lifesavers for these patients, but also big offenders when it comes to
costs.
By the numbers: Prescription
drugs account for about 40% of this group’s
costs, not counting rebates — compared with just 10% for the country
as a whole.
- Their
bills just for prescription drugs average out to about $34,000 per year.
That’s much more than the average premium for
family coverage.
Why it matters: These are
exactly the people our insurance system is failing. They have insurance and a
major illness, but still struggle with their medical bills as deductibles and
other out-of-pocket costs keep rising faster than wages.
One solution might be
to exempt this small group of high spenders with serious illnesses from drug or
other copays, and limit their deductibles.
- Congress
is also considering proposals to lower the cost of the most expensive
drugs, which could make a dent in both employer and employee spending for
this population.
The bottom
line: I have had family members in the 1.3%.
- I
know from experience as well as the data that we should take care not to
sacrifice needed care as we try to reduce spending for this small group of
very high spenders with complicated medical needs.
No comments:
Post a Comment