In between jobs and without insurance, Toby, 36, a restaurant worker from Kansas, had to resort to dangerous measures when it came to managing his daily medications. Trained as a medic in the U.S. Army and later in civilian clinics, he used what he knew about drug half-lives to stretch them out.
"I had to strategically space out my prescriptions so I could make it last,” he says. For 90 days, he couldn’t afford his HIV medication, drugs that cost upward of $2,000 each month. “I would skip doses or take the medicine every other day.”
Toby isn’t alone. Almost 8 percent of Americans didn’t take their medication as prescribed in 2013, according to recent findings from the National Health Interview Survey. Among uninsured adults, that rate was 14 percent.
The toll on your health
Not following the directions for your prescriptions can complicate your health.
For example, if you are suffering from an infection, failing to take your prescribed medications as directed could cause the illness to become resistant to antibiotics. If you take drugs for a chronic condition, you could increase your risk of suffering a potentially deadly event.
“For those with chronic conditions, such as those with heart disease, diabetes or hypertension, taking their daily medications can mean the difference between being in the hospital or being healthy,” says Dr. Michael Kedansky, a family physician.
For Toby, just three months of not taking his powerful HIV medications as directed had serious effects. (Only his first name is being used to protect his privacy.)
“I had taken my medicine faithfully for so long and it had worked so well that when I had my regular blood work, the virus was always ‘undetectable,’” he says. “I didn’t really feel any effects of not taking my medicine until I went in for blood work after my insurance kicked back in.”
For the first time in years, the HIV virus in his blood was detectable.
The US spends more on prescriptions than other developed countries
Americans spend more on prescription drugs than residents in all other Western nations. The Organization for Economic Co-operation and Development (OECD) estimates that per capita drug costs average $498 annually in its 34-member nations compared with more than $1,000 in the U.S., which ranks first. (Health systems and laws vary among the member nations). Paradoxically, the OECD finds life expectancy in the U.S. (78.7 years) to be far below the OECD average (80.2 years).
This major gap in spending persists despite a recent drop, and that’s due to several costly drugs losing their patents and making less expensive, generic versions available.
For example, copaxone, a drug used in the treatment of multiple sclerosis, costs an average of $3,903 in the U.S. The same drug costs $862 in England, according to the International Federation of Health Plans. Nexium costs $215 for the average American but just $23 in the Netherlands. These same price differences appear across many of the most popular prescription drugs.
Research and profit drive costs
The drug industry blames expensive drugs on the cost of doing business in the U.S.
PhRMA, an industry group representing some of the biggest names in pharmaceuticals, says it take 10 to 15 years on average to take a drug from idea to your local pharmacy, to the tune of $1.2 billion per drug on average.
In 2013, PhRMA-member companies spent $51.1 billion on research and development, up from $2 billion in 1980.
But R&D isn’t the only driver of consumer cost. The World Health Organization (WHO) reports that the global pharmaceutical market is worth an estimated $300 billion, with large drug makers operating at profit margins of 30 percent.
These costs are being passed along to American consumers, but many can’t afford the price.
“I see many patients resort to unhealthy practices in an effort to save on prescriptions,” Kedansky says. “Some are comfortable telling me when they can’t afford their medications, but others just go without.”
For Toby and others like him, dangerous decisions like skipping doses don’t come easily.
“I was scared and doubtful,” he says. “It put me on edge. But all I could do was hope it would work in my favor in the long run.”
Now, two months after getting back on insurance, his blood work shows signs of recovery, but not to where it was before his three-month gap.
Ways to save on prescriptions
Kedansky says talking with his patients about their ability to afford their prescriptions is crucial in ensuring they follow their treatment protocol. He often asks them directly about how their medication costs affect their lifestyles, and then recommends other, less expensive medications or assistance programs if needed.