A Health Care Crisis for the Underinsured
Patients who cannot afford their medications must fight two battles— their disease and the financial burden it places on their families.
In the public debate on health care, little attention has been paid to the underinsured—those who have private insurance or a Medicare Part D plan but still can’t afford the co-payments or deductibles for the expensive medications they need. For patients with chronic disease, cancer or other life-altering conditions, average co-payments for a single dose of prescribed specialty therapeutics can range from $300 to over $3000 per month.
These underinsured patients face many of the same problems as the uninsured—they are forced to go without needed medical care, they can’t afford to fill their prescriptions, and they suffer from severe financial stress—but they are not eligible for most free drug or patient assistance programs, leaving them with few alternatives. If they can’t afford their medications, they may be forced to do without them, go into debt to obtain them, or stop taking them against doctor’s orders, with serious effects on their health and quality of life.
Facts and Figures
Recent studies have revealed some disturbing facts:
- 16 million people (12% of U.S. adults with health insurance) were underinsured in 2003, and 43% of those with chronic diseases were either underinsured or uninsured.
- More than 14 million adults with chronic conditions (over half of whom were low income) could not afford all of their prescription drugs, and 20% were elderly, 20% were uninsured, 20% had public insurance such as Medicaid, and 40% (more than 5.5 million people) were privately insured, working-age adults.
- High co-pays and out-of-pocket expenses for prescription drugs lead people with chronic illnesses to restrict their use of these medications, leading to a significant decline in their health.
- Medicare beneficiaries with chronic diseases face significantly higher costs and are most impacted by the so-called “doughnut hole” in coverage, and most of the pharmaceutical assistance programs that offered free or low-cost drugs to lower-income patients will no longer do so for those with Medicare drug coverage.
- A 2005 Harvard study found that more than half of all personal bankruptcies are the result of medical debt by those with health insurance, and ongoing chronic illnesses are by far the most common reason.
The number of Americans living with chronic disease, cancers or life-altering conditions is staggering:
- Breast Cancer: Nearly 200,000 women (one every three minutes) will be diagnosed with invasive breast cancer and more than 40,000 will die this year. Breast cancer is the most frequently diagnosed cancer in women.
- Colorectal Cancer: Over 112,000 will be diagnosed and 52,000 will die this year.
- Lung Cancer: Over 213,000 will be diagnosed and 160,000 will die this year.
- Multiple Sclerosis (MS): About 400,000 have been diagnosed, including 8,000 to 10,000 children.
- Rheumatoid Arthritis: Over 2.1 million have been diagnosed, and it affects 2.5 times more women than men.
- Asthma: Over 20 million have been diagnosed, and about 5000 die each year. Nine million of those diagnosed are children under 18, and 4 million children had an asthma attack last year.
- Myeloma: Over 50,000 have it, 11,000 will die this year, and 15,000 new cases are diagnosed each year.
Our Solutions
The Chronic Disease Fund is one of the few charitable organizations providing financial assistance to underinsured patients with chronic disease, cancer or other life-altering conditions. Before receiving aid from the Fund, our average patient unsuccessfully sought help from four to six other non-profit organizations. By funding their drug co-payments and providing free therapy management services, the Chronic Disease Fund eases the financial burden to patients, ensures them access to the medications they need, enables them to experience the full benefits of their treatment by increasing drug compliance, and assists them in monitoring their health over time.
The Chronic Disease Fund has had an extraordinary impact on the health, quality of life, and financial well-being of over 24,000 patients since 2003, and we currently provide financial assistance to over 10,000 patients each year.