Right now, most Americans have some form of health insurance. Recent data from the Centers for Disease Control and Prevention indicates that, between January and September of 2016, only around 9 percent of the total U.S. population was uninsured. But that’s still over 28 million Americans who didn’t have access to the benefits of health insurance. Part of being uninsured means having to pay sometimes ridiculously high prices on necessary prescription drugs while the insured have access to lower rates. That’s a big problem for many, and it may get worse if the American Health Care Act gets approved by the Senate in its current form and shakes up the changes that Obamacare made.
One thing that might help is the recent move by GoodRx, a company that works with pharmacies to provide discounts on certain drugs, and Express Scripts, a major pharmacy benefit manager. Recently, they launched Inside Rx, a program that offers lower prices on certain “frequently used” brands and generic drugs to customers who do not have health insurance, and to those with high deductibles. It isn’t a perfect solution, however. There are many limits on who is eligible, and not all drugs may receive what the program calls “significant savings.” Offering cheaper drugs for the uninsured is a short-term solution at best, whereas expensive medicine is a huge long-term problem. But, another benefit that Inside Rx might bring is encouraging other pharmacy benefit managers to launch similar programs of their own so they can compete with Inside Rx. If that happens, then those who cannot access any insurance will have a wide variety of options for getting the drugs they need.
Inside Rx won’t be sufficient by itself for helping the uninsured primarily because of its limits on eligibility. For example, Inside Rx’s FAQ states that you aren’t eligible for Inside Rx if you’re eligible for Medicare, Medicaid or “other state or federal funded benefit plans.” People aged 65 or older are also ineligible. Another issue is that the biggest discounts only go to about 40 different drugs, meaning that even if you do qualify, you still might not get an affordable price for the drug you need. This program is a step forward, but still only a baby step.
Hypothetically, Inside Rx’s drawbacks might still end up doing good for those who don’t qualify for it. Since Inside Rx won’t cover every uninsured person, other companies can come in with their own programs that other uninsured people will qualify for. A big reason this will likely happen is that pharmacies that are participating in Inside Rx pay a “small fee” to Express Scripts whenever a customer uses an Inside Rx card. The money collected from those fees, as well as the promise of attracting more customers, is all the incentive that other companies will need to get involved with programs of their own. If they get in on this, it will result in the uninsured having access to more options for purchasing prescription drugs.
Again, however, programs like these are only short-term solutions. Arguably, programs like Inside Rx are only necessary because of the convoluted ways in which companies determine drug prices. As with many industries, revenue is the primary factor in determining the price of a drug. And amid the complicated process of drug manufacturers negotiating with insurers and dealing with the rules of government programs like Medicare and Medicaid, affordability and the well-being of the customer are pretty much forgotten. The problem of absurdly expensive drugs is not going to go away without serious, comprehensive reform to the healthcare system and the ways that drug prices get set.
For right now, Inside Rx is an adequate first step forward in improving life for those who cannot afford health insurance or whose health insurance may be threatened by partisan politics. Inside Rx is somewhat limited in who it can help, but this just means that other programs can crop up and provide for those who can’t benefit from Inside Rx. Still, these programs will only treat the symptoms of a larger sickness, namely all the problems with the American healthcare system, particularly the problem of pricey drugs. If we want to make life easier for those who do not have insurance, or who have a health plan with high deductibles, we’ll have to fix our healthcare system in a way that puts health first.