The Impact of Medication Cost on Dialysis Patients.

Abstract

Americans spend more money on prescription drugs than any other nation in the world. In 2018, spending on medicines, including over-the-counter drugs, in the United States was $1229 per person. This cost really sets us apart from most other countries (1). In Europe, the second-largest pharmaceutical market after the United States, governments negotiate with the drug companies directly, limiting what their health systems pay. The US free market economy, however, does not allow for direct negotiation with drug companies. Instead, the compensation of numerous stakeholders (from insurance companies to pharmacy benefit managers) is negotiated throughout the pharmacy supply chain, adding considerably to the final cost of medications (2). The result of these drug cost disparities is that people in the United States are far more likely to do without medications due to cost concerns. One in five US adults (11% of all patients) said they failed to complete a prescribed course of medicine because of cost. People with CKD and ESKD are even more profoundly affected by medication costs. Among patients enrolled on Medicare, per person per year out-of-pocket costs for Medicare Part D covered drugs in 2018 were $440 for all patients with ESKD, $381 for those on hemodialysis, and $569 for those on peritoneal dialysis (3). Between 2009 and 2018, total Medicare Part D spending, in inflation-adjusted dollars, rose by approximately 80% in those with ESKD (from US$1.9 billion to US$3.4 billion) and by approximately 50% in those without ESKD (from US$44.0 billion to US$67.3 billion). This increase is due to both the increased numbers of patients with CKD and ESKD, and to higher …