Among all respondents, 53% of beneficiaries reported having had a serious problem paying a medical bill of any kind. Thirty percent of respondents said prescription drugs created the largest burden.
A national survey published this week in Health Affairs reveals the extent to which financial hardship is affecting seriously ill Medicare beneficiaries, with prescription drugs posing the greatest burden.
The survey was released the same week that the Trump administration reportedly will not consider a drug pricing proposal from House Speaker Nancy Pelosi, D-California, that would give Medicare the authority to regulate drug prices.
The phone survey in the current study was conducted between July 6 and August 18, 2018. Among all respondents, 53% of beneficiaries reported having had a serious problem paying a medical bill of any kind. Thirty percent of respondents said prescription drugs created the largest burden, followed by bills for hospitals (25%), ambulances (20%), and emergency department visits (20%).
Those costs have consequences on the rest of their lives, respondents said, such as plowing through most of their savings (36%), being contacted by a collections agency (27%), and not being able to afford food, heat, and housing (23%).
In addition, the financial struggles reported by these ill beneficiaries included emotional or psychological distress (45%) and problems caring for a dependent (24%).
The survey asked questions of people enrolled in both traditional fee-for-service Medicare as well as those in Medicare Advantage and also those dually enrolled in both Medicare and Medicaid. Interestingly, there was significant differences between beneficiaries who were and were not dually enrolled.
The report notes that 55% of all high-need patients are 65 or older. Other studies have reported that high-need, high cost conditions such as dementia and cancer lead to high out of pocket costs.
Even if a patient’s level of medical need remains constant, healthcare costs have been outpacing inflation. In addition, while advances have led to increased efficacy in treating many diseases, the advances come with a high price tag.
The authors said this is the first report to look specifically at seriously ill Medicare beneficiaries.
The list of conditions affecting beneficiaries included the following:
The sample included 742 Medicare beneficiaries; 607 answered the questions directly, and proxies, such as spouses, responded for the remaining 135 beneficiaries. The response rate was 21% (margin of error, ±4.6%).
Dual enrollees were significantly younger, less likely to be white, more likely to be black or Hispanic, and more likely to be low-income compared to those not dually enrolled.
Dual enrollees were also more likely to have difficulties with comprehending what insurance would cover for hospital admissions, but less likely to receive a bill afterwards.
Overall, only 46% of the seriously ill felt adequately informed by health professionals about what costs their insurance would cover.
Relatives of the seriously ill were also affected by the cost burden, the results showed; 25% of the seriously ill said that costs were a major burden on their family, while 30% reported a minor burden. The majority of respondents—60%—said family and friends helped. But the ramifications of providing help included their own financial problems: lower income, lost or changed jobs, or reduced hours. Other types of burdens included emotional stress.
Distinguishing the type of burden among different types of Medicaid beneficiaries is an important area for future research, the authors said.
The Commonwealth Fund supported the study.
Reference
Kyle MA, Blendon RJ, Benson JM, Abrams MK, Schneider EC. Financial hardships of Medicare beneficiaries with serious illness. Health Aff (Millwood). 2019;(38)11: 1801-1806. doi: 10.1377/hlthaff.2019.00362.
AMCP Posters Tackle Interchangeability and Medicaid, Factors Driving Biosimilar Access
April 24th 2024Two posters from the Academy of Managed Care Pharmacy (AMCP) annual meeting explore how an interchangeable insulin glargine biosimilar plays into Medicaid budgets and the top factors driving access to biosimilars.
A New Chapter: How 2023 Will Shape the US Biosimilar Space for 2024 and Beyond
December 31st 2023On this episode of Not So Different, Cencora's Brian Biehn and Corey Ford take a look back at major policy and regulatory advancements in 2023 and how these changes will alter the space going forward.
The 6 Key Policy Factors to Ensure Biosimilar Market Sustainability
April 16th 2024Magnus Bodin, senior director and head of international access and policy at Biogen, presented warning signs for unsustainable biosimilar markets as well as key factors needed to create effective policies and future-proof biosimilar markets globally.
What AmerisourceBergen's Report Reveals About Payers, Biosimilar Pricing Trends
May 28th 2023On this episode of Not So Different, Tasmina Hydery and Brian Biehn from AmerisourceBergen discussed results from a recent survey, that were also presented at Asembia 2023, diving into the payer perspective on biosimilars and current pricing trends across the US biosimilar industry.
What Clinicians Need to Know About Using Biosimilars to Treat IBD
April 13th 2024A review article, intended to act as a guide for clinicians, summarizes the available infliximab and adalimumab biosimilars for treating inflammatory bowel disease (IBD) as well as others that are coming down the pipeline.
Global Biosimilar Market Projected to Reach $1.3 Trillion by 2032
April 11th 2024The global biosimilar market is projected to surge from $25.1 billion in 2022 to approximately $1.3 trillion by 2032, with a compound annual growth rate of 17.6%, driven mainly by the increasing prevalence of cancer and the cost-effectiveness of biosimilars, as outlined in a report by Towards Healthcare.