Three life-saving drugs costing hundreds of dollars a month could potentially be subsidized to patients in Santa Clara County. The Board of Supervisors voted unanimously on Jan. 28, to investigate a pilot program to cut costs for insulin, epinephrine auto-injectors (EpiPens) and asthma inhalers.
The proposed plan could be the first of its kind in the nation, said Supervisor Joe Simitian, who initiated the proposal. The county would purchase extra supplies of these drugs through its hospital system, including El Camino and Saint Louise Regional hospitals, at their regular price. They would then be distributed for a low fee or for free through county-run pharmacies and other health care partners.
Insulin is used to control diabetes; epinephrine auto-injectors are used for anaphylactic allergic reactions; and asthma inhalers control asthma attacks. Diabetes, severe allergies and asthma are common chronic conditions and can be managed with proper medication, but they can also be catastrophic if not effectively controlled, resulting in complications, hospitalization and death, Simitian said in a Jan. 28 report to the board.
In Santa Clara County, 14% of adults and 7% of children were diagnosed with asthma; 8% of adults had diabetes; and 10% were diagnosed as prediabetic, according to the most recent county Public Health Department reports dating 2013-14. The numbers were higher among lower-income residents and in communities of color.
In 2015, 3.6 million patients across the nation were prescribed EpiPens to prevent complications from allergic reactions, according to the Wall Street Journal.
The cost of medications to control these diseases has skyrocketed in recent years. Insulin prices are an average $450 per month in 2016, Simitian noted. A vial of insulin from a well-known maker valued at $12 in 1996 now costs $275. Under basic consumer price index inflation, that same $12 vial would be sold for $20 today. EpiPens can have a price tag of more than $650 for a package of just two injectors, and the generic version of the drug still costs $300. The price of asthma inhalers has seen a similar increase.
These prices are out of reach for many patients. A study in the Journal of the American Medical Association in January 2019 noted as many as 1 in 4 people with diabetes are cutting back on their doses or skipping them altogether to save money.
The results can be fatal. Diabetic crisis, anaphylaxis (a potentially life-threatening allergic reaction) and severe asthma attacks can result in expensive trips to the emergency room. Not taking insulin can increase the chance of a hospitalization by as much as 77%, according to a 2015 study. The county would likely recoup some of its costs for the program through reduced trips to the emergency room, which have driven up health care fees in the county, Simitian said.
Although many residents have insurance that partially or completely covers their costs or they have access to government programs providing a similar subsidy, an increasing number of people have high-deductible insurance plans. They are paying hundreds or thousands of dollars per month for the medications they need to stay alive. They are "the missing middle" of health care, Simitian said.
"Insulin, EpiPens and inhalers are not a nice-to-have but a have-to-have. The debate about the high cost of prescription drugs is a complicated one. But I know this: No one should have to break the bank in order to afford life-saving medication," he said in a press release issued Tuesday.
The proposal builds on work Santa Clara County already has in place to address unaffordable medication. The county collaborates with Sirum, a Palo Alto-based nonprofit that collects unused medication from local pharmacies and nursing homes and delivers them to the county's Better Health Pharmacy. The medication is distributed to uninsured and underinsured patients. In 2019, Health Pharmacy filled 31,940 prescriptions, a significant increase over 24,123 prescriptions in 2018. The drug redistribution program operates under legislation authored by Simitian when he served in the state Senate.
Luisa Buada, CEO of the Ravenswood Family Health Center, which serves many low-income families, said not taking preventative measures leads to costly emergency room and inpatient care.
"Improving access to life-saving medications is vital for the well-being of our middle and low-income families and a prudent economic investment in public health care," she said in the press release.
The proposal has the support of some local public health providers and advocacy organizations, including the American Heart Association and the American Diabetes Association's Northern California office.
In March, the county's Health and Hospital Committee chaired by Simitian will receive staff's findings, which are expected to include options for the pilot program, projected cost analysis, an analysis of potential cost savings in reduced emergency room visits, a plan to gather data and analyze the program and options for funding nonprofit organizations donating unused medication to the Better Health Pharmacy.