Charles Green Week 5 Discussion Post

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Hello Everyone, Many patients of the United States cannot afford their prescription medications. According Mykyta & Cohen, 2023, 9.2 million adults in the United States (US) reported not taking their prescription medications due to cost. According to Cefalu et al. (2018), besides chemotherapy and antiviral medications, insulin was among the most expensive prescription medications in 2021, costing insured patients an average of $63 per prescription and costing uninsured patients an average of $123 per prescription. Breast cancer treatments and cost vary widely as few cancers have similar treatment plans, but according to Semin et al., 2020, the average cost of breast cancer treatment is about $35,000 for the first year and about $3,500 per year thereafter. Even those who have insurance will expect to pay their yearly out of pocket maximum of ~$2,000 to ~$6,000, and those with a family plan may expect to pay their out-of-pocket maximum of ~$12,000 to ~$16,000 a year in the first year alone. To combat the high cost of prescription drugs for Californians, Governor Newsom has been pushing SB 852 (Office of Governor Gavin Newsom, 2020), which will allow California to create its own generic drug label, and to make and distribute generic drugs under that label. As California is the most populous state, it has extraordinary negotiation power with drug companies, that it can use to negotiate a lower cost of the drug for Californians, or if the maker won’t play ball, California can build a manufacturing plant and make the drug itself for pennies on the dollar compared to what the original maker charged Californians. The ani-retroviral medication Truvada, used to treat an HIV infection in combination with another drug, or used by itself for daily HIV prophylaxis (Prep) cost an average of $1,800 a month. While of course that is staggering in light of the average net income for adults in the US, it should be noted that most prescription holders receive their monthly HIV prophylaxis for free or for less than $60 a month due to hundreds of programs created to ensure that HIV prophylaxis is available to all, regardless of ability to pay for it. I want to serve the LGBT community so I will now focus on programs that help people of all income ranges afford Prep. According to the California Department of Public Health, 2023, Prep is now considered preventative care and therefore is covered by Medi-Cal, Medicare, and Medicaid, and all other insurers that participate in the California health exchange, and nearly all insurance plans offered by California employers, at no charge to the insured. Those who are insured and even undocumented have several choices of programs that also provide Prep and other forms of care, regardless of financial capability. For example: PrEP-AP Temporary Coverage GetPrepLA HeyMistr.com The California Pre-Exposure Prophylaxis Assistance Program (PrEP-AP). According to County of Los Angeles Public Health (2023), there are more than a dozen different agencies that will provide Prep, free of charge, regardless of financial income or immigration status. All of those agencies also offer sexual awareness education that includes education pertaining to HIV/AIDS treatment and prevention. In the time since Prep was approved, in July of 2012, I have seen countless billboards, flyers, social media campaigns,

magazine articles and street festival booths referring to Prep. I honestly do not a single gay person who does not know what Prep is, and or is not on Prep themself. One way that providers influence the cost of a patient’s prescription drug regimen is by ordering generic versions of drugs whenever possible. As hopefully we all know by now, I truly cannot image how anyone with an associated degree or higher in health care cannot know this, when a drug is first created and approved, the maker has a certain number of years for which they exclusively are the only maker of that drug and can charge whatever they want to for the drug. After that period of time, other drug makers can make generic versions of that drug, and because multiple makers are then competing for consumers, the prices they charge will be substantially less than the price the original exclusive maker charged. However, the original maker can and nearly always does continue to make the original drug under the original brand name, that some people continue to buy, and therefore, technically, a provider such as a FNP could order the original version of the drug, by its original brand name, and the pharmacy would have to fill the prescription with that exact drug for the more expensive price. Or the FNP can order the generic version of the drug, which has a less expensive price than the brand name version. References California Department of Public Health. (2023). PrEP-AP main page . www.cdph.ca.gov. Retrieved January 11, 2024, from https://www.cdph.ca.gov/Programs/CID/DOA/Pages/PrEP- AP.aspx Cefalu, W. T., Dawes, D. E., Gavlak, G., Goldman, D., Herman, W. H., Van Nuys, K., Powers, A. C., Taylor, S. I., & Yatvin, A. L. (2018). Insulin access and affordability working group: Conclusions and recommendations. Diabetes Care , 41 (6), 1299- 1311. https://doi.org/10.2337/dci18-0019 County of Los Angeles Public Health. (2023). PrEP centers of excellence – GetPrEPLA . https://getprepla.com. Retrieved January 11, 2024, from https://getprepla.com/centers-of- excellence McKenney, J., Chen, A., Hoover, K. W., Kelly, J., Dowdy, D., Kasaie, P., Sullivan, P. S., & Rosenberg, E. S. (2017). Correction: Optimal costs of HIV pre-exposure prophylaxis for men who have sex with men. PLOS ONE , 12 (7), e0182593. https://doi.org/10.1371/journal.pone.0182593 Mykyta, L., & Cohen, R. (2023). Characteristics of adults aged 18–64 who did not take medication as prescribed to reduce costs: United States, 2021. NCHS Data Brief , 470 . https://doi.org/10.15620/cdc:127680 Office of Governor Gavin Newsom. (2020, September 28). Governor Newsom signs legislation advancing California’s fight to lower prescription drug prices . www.gov.ca.gov. Retrieved January 11, 2024, from https://www.gov.ca.gov/2020/09/28/governor-newsom-signs- legislation-advancing-californias-fight-to-lower-prescription-drug-prices/

Semin, J. N., Palm, D., Smith, L. M., & Ruttle, S. (2020). Understanding breast cancer survivors’ financial burden and distress after financial assistance. Supportive Care in Cancer , 28 (9), 4241-4248. https://doi.org/10.1007/s00520-019-05271-5 Hello Olga and Happy Wednesday, According to Besaw & Dusetzina (2022), in 2019 alone, more than 3.5 million Americans over the age of 65, and 1.8 million Americans under 65 could not afford their prescription medications. According to the website for Senator Chuck Grassley (Senator Chuck Grassley, 2019), 13% of adult Americans knew a family member who died because they could not afford medical treatment, including their prescription medications. We both listed several programs for helping people afford their prescription medications, which is pawsome, but then I stopped to think, “I can look this stuff up. I can google search those programs, I can click on all the links, but what about people who can’t use a computer or don’t have access to one?” Yikes. There are literally hundreds of programs for helping afford their prescriptions, and I can peruse them easily because I have six computers at home, plus my two smart phones. But the elderly and others less technologically able than I am, must have a beast of time finding assistance. I don’t even know where’d they go to for that kind of help. As a provider, I couldn’t take time from my day to find people these programs because that would all I did all day, and insurers don’t pay us for that. I feel overwhelmed just thinking of being responsible for helping connect people to the cost assistance programs they need, and I’m me. According to Birch (2023), most adults over the age of 65 in the US spend an entire 8 hours a month coordinating healthcare for themselves or another. Now imagine if that was us trying to coordinate care for all our patients. Like I said, that would be all we did. Having so many cost assistance programs available now is a great thing but in having so many we’ve created a new problem, which is helping people connect to them. They say necessity is the mother of invention. We needed more cost assistance programs, and now we have them, but now we need people to help others navigate them. What or who will arise to mee that need? Only time will tell I suppose. Be Safe Everyone, Chip References Besaw, R. J., & Dusetzina, S. B. (2022). Persistent prescription drug affordability challenges for Medicare beneficiaries with multiple chronic conditions—What goes up must come down? JAMA Internal Medicine , 182 (2), 195. https://doi.org/10.1001/jamainternmed.2021.7454 Birch, J. (2023, May 17). U.S. adults spend eight hours monthly coordinating healthcare, find system “Overwhelming” . AAPA. Retrieved January 31, 2024,

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from https://www.aapa.org/news-central/2023/05/u-s-adults-spend-eight-hours-monthly- coordinating-healthcare-find-system-overwhelming/ Senator Chuck Grassley. (2019, November 12). ICYMI: 58 million American adults can’t afford prescription drugs . /www.grassley.senate.gov. Retrieved January 31, 2024, from https://www.grassley.senate.gov/news/news-releases/icymi-58-million-american- adults-can-t-afford-prescription-drugs Hello Ella and Happy Wednesday, In my work as an investigator for the California Department of Public Health, I usually represent the Centers for Medicare and Medicaid Services. I know that sounds strange. Ultimately most health care facilities participate in the CMS program, and when things go wrong CMS asks California to lend them my services as an investigator and ultimately it is CMS that I bill. Anyway the point is that you were talking about Medicare Part D and CMS yada yada and I thought, “wow she knows the CMS system better than I do and I flash their badge daily.” CMS services and programs can be extremely confusing. But luckily, we Californians will soon not have to deal with CMS as much, because California is about to start making and distributing its own band of mediations. Thanks to the California Affordable Drug Manufacturing Act of 2020, California will soon be legally able to make and distribute prescription drugs, the first of which will be insulin ( CalRx, 2023). And due to the number of Californians that will want to buy them, this will create an extreme amount of competition among other drug makers to lower their prices or lose on the business of nearly 30 million consumers (Statista, 2020 ) . In other words, California is about to devastate the prescription drug market price table. California’s drug production program won’t be for profit, which means it will be able to make and sell drugs at a price far less than they are currently sold for by for-profit drug companies. The cost for the cost popular drugs will after insulin will be so low, hopefully other cost assistance programs will not be necessary. Blood pressure medications, anti-lipid and cholesterol medications, anti-diabetes medications other than insulin, in just a few years will all be drastically less expensive than they are now and I am very excited for the people of California and for the people of other states who follow California’s example. Everyone Please Drive Slowly, and Make Safe Choices , Chip References CalRx. (2023, March 30). Making prescription drugs more affordable for Californians . calrx.ca.gov. Retrieved January 31, 2024, from https://calrx.ca.gov Statista. (2020, June 22). U.S. estimated 21 and over resident population by state 2019 . www.statista.com. Retrieved January 31, 2024, from https://www.statista.com/statistics/589082/us-estimated-21-and-over-resident- population-by-state

Charles Green Week 5 Discussion Post

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