“If you’re paying out-of-pocket, Mr. Naple, that will be $1,600 for the one month of sildenafil. Is that something you will want to pay today?” the pharmacist inquired over the phone. You probably know my answer.
Sildenafil is one of three medications I take to keep my pulmonary hypertension under control. From where I stand, sildenafil is the most important of the three because it does the lion’s share to keep my pulmonary arterial pressures low. You can imagine my frustration when I told the pharmacist there was no way I could afford to pay for it. After I hung up, a fury began to stir inside me. How is it possible that I could potentially be priced out of the medication I depend on?
I am lucky. I am still able to work and that gives me access to health coverage that is affordable and high quality. But my new insurance provider isn’t up to speed on my medications, and won’t cover the one pill that I take three times a week without first processing a prior authorization request from my pulmonologist. Medications that treat PH are expensive. Counting the white tablets left in a slim orange cylinder, I have about six days before I run out. The out-of-pocket price is more than my monthly rent, and paying it would burn a hole in my checking account. What to pay? Rent? Student loans? Medication?
People across the country are facing these Sophie’s choices every day. And too little is being done in government to address this problem.
Thankfully, my partner reminded me to check out Blink Health, a digital pharmacy that offers a pre-negotiated low price on more than 15,000 generic prescription drugs. I considered using Blink before, but even the negotiated price on sildenafil was more expensive than what I was paying at the time with insurance. Now, it doesn’t look so bad when compared to the out-of-pocket price tag. This is a workable, temporary fix while I wait for my insurance company to catch up with my medical team. But it leaves me thinking, yet again: It’s tough to be chronically ill in America.
I am still looking for serious discussion on policy solutions to bring down the high costs of prescription drugs. The ongoing debate over the future of the ACA has not addressed the issue of prescription costs, and I wonder what kind of political will exists that might bring progress.
The Drug Pricing Lab is currently tracking a handful of bills in Congress to tackle prescription drug reform from one angle or another, including importing certain drugs from Canada, boosting the federal government’s negotiating power, improving access to affordable generic drugs, and a fair pricing notification when drug makers raise prices by a certain percentage over a number of years.
The question is: Do our elected officials possess the will to take on the powerful pharmaceutical industry, move these bills ahead, and get something done? I fear they don’t.
Where does this leave PHighters like you and me? I would be foolish to say that lowering prescription drug costs would be anything less than a David vs. Goliath fight. Moving the needle even a little requires the constituency and visibility to force political will toward change — just like the mobilization that greeted each healthcare debate this year. We can’t let this issue continue to founder. Mobilization could serve as the foundation in a much-needed fight to lower prescription drugs in the near future.
Follow me on Twitter: @mnaple.
Note: Pulmonary Hypertension News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Pulmonary Hypertension News or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to pulmonary hypertension.
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