Pharmaceuticals, Access to

Limited access to pharmaceuticals, or prescription drugs, is a problem that can have dire health consequences. The poor, minorities, and rural populations already suffering health disparities are more likely to face limited access. Using lower-cost generic medicines, when available, helps offset costs for under-and uninsured. Government programs like Medicare and Medicaid, as well as prescription assistance programs (PAPs), improve access for Many.

More than 2 billion people lack access to medicines worldwide, and millions die every year from diseases that are treatable. While manufacturing, infrastructure, and distribution inadequacies limit access in developing nations, the high cost of prescription medicines is an obstacle for patients everywhere. Prescription drug prices have more than doubled over the last decade. In the United States, where drug prices are the highest in the world, costs approach $280 billion a year.

Even for those with prescription drug coverage, access can be difficult given high copayments coupled with prior authorization and restrictive refill policies. Studies show that about one-quarter of Americans routinely skip doses or split pills because of high costs. More than one-third of all prescriptions written are never filled. Not taking medicines as prescribed is associated with adverse health outcomes: Studies link poor management of high blood pressure, diabetes, and cholesterol with medication noncompliance. Inadequate access is also associated with more emergency room visits and longer hospital stays, diminishing quality of life and increasing overall health care costs in the process.

The availability and utilization of generic medicines merits discussion. There are generic medicines to treat diseases with high morbidity, like heart disease, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and diabetes, but generics are underutilized. Several studies show that generic medicines are just as effective as their more-expensive counterparts; nonetheless, patients often request brand-name drugs instead. Critics claim pharmaceutical advertising clouds consumer judgment by promoting brand loyalty, but physicians also play a role. A 2004 study found inappropriate prescribing of brand-name medicines to treat high blood pressure, while clinical guidelines recommended a cheaper generic alternative. The practice added $1 billion to Medicare costs that year alone. Many physicians may not know generic alternatives exist. they may not know how much their patients spend on medicines either and so fail to suggest cheaper alternatives. Pharmaceutical companies also impede widespread access and use; pay-for-delay deals or reverse payments to generic drug manufacturers push back production and delay access to cheaper medicines for years.

People with the most difficulty accessing medicines are often those with the greatest need. The National Institutes of Health (NIH) Health Disparities Strategic Plan identifies racial and ethnic minorities, as well as those living in rural communities, at increased risk for early death due to health disparities. These groups suffer a disproportionate number of health-related problems made worse by inadequate access to prescription medicines. Studies show that Hispanics, blacks, and the poor are less likely to take medicines to treat high blood pressure and cholesterol than whites; in addition to an increased risk for heart [Page 1032]disease, they also experience diabetes in greater numbers. The risk of diabetes is 66 percent higher among Hispanics and 77 percent higher among blacks compared with whites.

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