As millions of people around the world relaxed after the Christmas break and began planning for the new year, the Rev. Dr. Unnia Pettus was awaiting word from her doctors on whether she would need to undergo emergency surgery.
The problem was an intestinal obstruction — but with a plethora of serious complications.
Pettus, an ordained minister, author and public relations expert, was leaning on her faith that the obstruction was not the return of a previously diagnosed colon cancer. The complications included the fact that surgeons were leery about operating because her heart was recently functioning at only 30-40%, based on an echocardiogram.
As Pettus described, it got even worse.
“I’m a 52-year-old African-American woman who discovered I had heart disease the day before my scheduled double mastectomy in November 2019,” she said. “My oncology cardiologists ran blood work and knew of my symptoms of extreme lethargy and insomnia and ordered an echocardiogram Hours later I received the call that my heart was too weak to endure the breast cancer surgery and rescheduled for weeks to start me on heart medications plus a heart-healthy diet change.”
She concluded, “I was now living with the number 1 and number 2 killer of women, moderate Cardiomyopathy Stage B and metastatic breast cancer.”
Unable to work because of this string of illnesses, Pettus has had to turn to close friends, complete strangers, and loved ones who she calls her “AngelTribe” to contribute to a GoFundMe campaign to help cover her medical bills and prescriptions. They include the heart drugs Candesartan, with an average retail price of $269.27 per month and Carvedillol, also with an average retail price of $285.97 per month; both prices depending on the severity of the heart ailment and the level of dosage.
“The GoFundMe campaign funds have helped me get the care and prescriptions I need, even under generic. But I thank God for my #AngelTribe, my angels who pray and believe in my miracle with me,” she said.
Pettus’s situation is unique – most people do not have anything close to an “AngelTribe” to help them pay for medical bills or lifesaving prescriptions. In fact, a recent study predicts that more than a million Medicare recipients could die over the next 10 years simply because of sicknesses that will occur due to their inability to pay the high costs of their prescription drugs.
“If current drug pricing trends continue, researchers estimate cost-related, non-adherence to drug therapy will result in the premature deaths of 112,000 beneficiaries a year, making it a leading cause of death in the U.S., ahead of diabetes, influenza, pneumonia, and kidney disease,” according to a study released in November 2020 by West Health Policy Center, a nonprofit and nonpartisan policy research group and Xcenda, the research arm of the drug distributor AmerisourceBergen. It also indicates that, unless prescription costs are somehow made more affordable – “Millions more will suffer worsening health conditions and run up medical expenses that will cost Medicare an additional $177.4 billion by 2030 or $18 billion a year for the next 10 years.”
As extreme as these numbers may sound to laypeople outside of medical science, the results, are well known to those involved in conducting the study.
“Unfortunately, these results are not surprising,” said Sean Dickson, West Health’s Director of Health Policy. “We know that over 58 million Americans have not been able to pay for their medicines over the past 12 months because of costs. and 34 million Americans know of a friend or family member who has died because they can’t afford medical treatment or drugs. And so, the fact that we’re able to tease out exactly how many seniors are dying in the Medicare population each year is unfortunately not surprising.”
The extreme prices contribute to serious complications and death when people have to ration their life-saving drugs because they can’t afford to take them as prescribed. Many have failed to take the medicines at all because they simply don’t have the money to pay for them.
The consequences outlined in the study results underscore the urgency being expressed by affordable health care advocates and civil rights leaders, who persistently urge state and federal lawmakers to pass legislation that could reduce prescription drug prices. Yet, according to Congressional Bill Status on Capitol Hill in Washington, D.C. – although more than a dozen bills were introduced during the last 116th Congress – not one passed both the House and the Senate to reach the White House and possibly become law.
“One of the biggest contributors to poor health, hospital admissions, higher healthcare costs and preventable death is patients failing to take their medications as prescribed,” said Timothy Lash, President, West Health Policy Center a news release announcing the results. “Cost-related nonadherence is a significant and growing issue that is direct result of runaway drug prices and a failure to implement policies and regulations that make drugs more affordable.”
Poor health outcomes – whether occurrences of certain diseases or the deaths from them – have often shown to disproportionately affect African-Americans. Although the study does not specifically break the outcomes down by race, indicators show that there are likely racially disparities in mortality, as diseases included in the study that disparately affect people of color, such as diabetes, COPD and atrial fibrillation, said Dickson.
“The price of prescription medications has skyrocketed in recent years. Between 2007 and 2018, list prices for branded pharmaceutical products increased by 159% and there are few signs of it slowing,” said the news release announcing the results.
Dickson went on to note that “the costs of doing nothing about high drug prices are too high especially when policy changes such as allowing Medicare to negotiate drug prices would result in saving millions of lives and billions of dollars.”
Among the study’s other key findings: “Because high drug prices and patient costs mean seniors cannot afford their medications, Medicare is projected to spend an additional $17.7 billion annually on avoidable medical spending due to health complications. Medicare negotiation is projected to reduce drug prices and seniors’ cost-sharing, which could prevent nearly 94,000 seniors’ deaths annually and save $475.9 billion.”, “
The escalating controversy over drug prices has long been monitored by experts in the bioethics community who contend the issue is a matter of medical ethics. “One of the fundamental principles of bioethics is non-malfeasance,” said Glenn Ellis, a visiting scholar at the National Bioethics Center at Tuskegee University and a Harvard Medical School research bioethics fellow. “That means, don’t do any harm. Whatever you’re getting ready to do to this patient, don’t harm them. So now, the cost of drugs being so high and so out of reach to so many people is causing people to split pills in half and skip days and to make choices between, ‘Do I get my food, or do I get my prescription this week?’ So, all of those things are causing harm to people. So, it’s a very fundamental ethical violation.”
He said money is the bottom line. “The problem is that the United States is the only developed country that has its health care system connected to the free market. So, the industry that provides prescription drugs has primary, fundamental obligations to the stockholders, the shareholders and the investors. So, that drives all of the decisions. How do I get the biggest return on my money? The core principle of economics is that pricing is set by supply and demand. If you control the supply, you can shape what the demand is going to be.”
Art Caplan, head of the division of Medical Ethics at the New York University Grossman School of Medicine, agrees that the decisions to save lives too often come down to economics – even for politicians. “The government has made noises about trying to look at pricing, but they never do because the industry is too powerful and lobbies too ferociously,” he said. “So, we end up having prices on things like insulin that are completely out of sync with what the rest of the world pays. We’re fools for doing that because we wind up putting profits ahead of health.”
This article is part of a series on the impact of high prescription drug costs on consumers made possible through the 2020 West Health and Families USA Media Fellowship.