Rising health care costs continue to put treatment out of reach for vulnerable communities in San Diego and across California, including many living with mental health challenges. Health care providers are reporting an increase in anxiety, depression and addiction due to the COVID-19 pandemic, financial fears, job loss, rising cost of living and many other factors.
Without meaningful efforts to address health care costs—specifically what San Diego patients pay at the pharmacy counter—we risk exacerbating a health crisis as patients delay or forego treatment altogether.
A growing body of evidence suggests that the impact of burdensome health care costs is already negatively impacting the mental health of California patients and their families. ONE California Health Care Foundation Poll 2021 found that more than half of Californians either skipped or postponed mental and physical health care because of cost.
And, according to his research Kaiser Family Foundation57% of Californians reported that they could not access the behavioral health care they needed.
California policymakers have made efforts over the years to improve what patients pay out-of-pocket for their drugs, including by reforming the prescription drug rebate system. this year, Senate Bill 1361 would have increased transparency into the opaque business practices of pharmacy benefit managers (PBMs) and required 90% of manufacturer rebates to be passed on to consumers at the pharmacy counter.
Health insurance companies and PBMs negotiate significant discounts and rebates when purchasing drugs from drug manufacturers. The price they pay after rebates is lower than the “list price” of the drug. On average, drug manufacturers discount 40% of a drug’s list price.
In 2020, the Department of Managed Health Care reported that health plans received more than $1.4 billion in rebates, up 57% from 2017. Due to a lack of transparency and accountability, nothing requires health insurance plans to ensure that the patients benefit from these discounts.
Passage of SB 1361 would have helped lower patients’ costs for their prescription drugs and helped increase adherence to their regimens. Unfortunately, California lawmakers have once again failed to reform the byzantine system of drug pricing and rebates that health insurers and pharmacy middlemen use to make a profit off the backs of patients.
According to San Diego County Health and Human Services Agency, approximately 1 in 4 San Diego County adults experience a mental health challenge. Nationally, 1 in 5 adults experience mental illness and 1 in 20 experience a serious mental illness, according to the National Alliance on Mental Illness.
Patients living with mental illness face a number of barriers to successfully managing their condition, including persistent stigma surrounding mental illness and barriers to proper diagnosis. Managing mental health conditions often requires a series of treatments and a challenging process of trial and error to find which treatment regimen works best for the individual patient.
Once a doctor and patient find the effective treatment or combination of treatments, patients must navigate whether or not the treatments are covered by their insurer. After all, the cost of treatment should never be a barrier to accessing care and should never be a reason for someone to leave treatment.
We urge lawmakers to prioritize important prescription drug cost policies that will reform the current PBM rebate system and help reduce the cost patients pay in coffers for their drugs. For some Californians, it’s a matter of life and death.
Kathryn Nacario is its executive director National Alliance on Mental Illness San Diego and Imperial Counties.
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