County moves forward to cut costs for life-saving medications
SAN JOSE – Santa Clara County is moving forward with two new pilot programs to provide three life-saving medications at no cost, with no co-payments, for struggling Santa Clara County residents. The new program begins on November 2nd.
The three subsidized medications are insulin (for diabetes), epinephrine auto-injectors/EpiPens (for anaphylactic allergic reactions), and asthma inhalers (for asthma attacks). One program will be administered by the County’s Better Health Pharmacy and the other program will be administered by Valley Medical Center (VMC). Both are the result of a proposal made by County Supervisor Joe Simitian earlier this year.
“Insulin, EpiPens and inhalers are not a nice-to-have, but a have-to-have,” said Simitian, Chair of the County’s Health and Hospital Committee. “The debate about the high cost of prescription drugs is a complicated one,” he said. “But I know this, no one should have to break the bank in order to afford life-saving medication.”
The first pilot program will be administered by VMC. It will be six-months long and will subsidize 100 percent of the cost of the three medications to 330 Santa Clara County residents that fall into the “missing middle” – patients who do not qualify for government-provided health care insurance and are otherwise under-insured. Eligible patients will already have to be enrolled in the County’s Healthcare Access Program, an earlier Simitian effort to subsidize the health care costs of those that are under-insured or do not have insurance.
The second pilot program will be administered by the County’s Better Health Pharmacy, the first and only dedicated drug donation pharmacy in California, and will provide insulin to 50 Santa Clara County residents. The costs associated with the drug will also be 100 percent subsidized and the pilot program will last six months.
In 2019 alone, the County’s Better Health Pharmacy dispensed 31,940 prescriptions, a significant increase over 24,123 prescriptions in 2018. The County’s drug redistribution program operates pursuant to legislation authored by Simitian when he served in the California State Senate.
The goal of both pilot programs is to test the feasibility of subsidizing life-saving medications for those that are at risk of not being able to financially afford their medications.
In addition to subsidizing the copayment cost, eligible HAP patients who enroll in the County’s MTM (medication therapy management) pilot will receive a pharmacist led MTM service to improve medication adherence. The MTM service includes but is not limited to side effect management, medication reconciliation, adherence monitoring, refill coordination, and therapeutic validation, collectively known as SMART case management. The SMART model is the standard of care for pharmacy medication management services at the Health System.
“Californians need immediate action to lower drug prices, especially for life-saving medications such as insulin, asthma inhalers, and EpiPens. The pilot programs that Santa Clara County is announcing today will save lives, save families’ budgets, and save taxpayer dollars,” said Congresswoman Anna Eshoo, who serves as Chair of the House Health Subcommittee. “I applaud the County for stepping up to the challenge of addressing unsustainable drug prices.”
In proposing the County’s effort, Simitian noted that “In the last ten years alone, the price of insulin has tripled,” with the average monthly cost topping $450 in 2016. A study in the Journal of the American Medical Association in January of 2019 notes that as many as one in four people with diabetes are cutting back on their doses or skipping them altogether to save money. The results can be fatal.
“Type 1 diabetes requires intensive insulin therapy in order to stay healthy. Without it, our children may develop complications like blindness, heart disease, and lower leg amputations later in life,” said Alan Kissick, Executive Director of Northern California, American Diabetes Association. “People with diabetes, and their families, have enough to worry about. We are pleased to support this plan that provides access to this life-saving medication.”
Diabetes, severe allergies, and asthma are all chronic, lifelong conditions that are common, and can be well-managed with proper medication. However, when there are barriers to access, like high prices and high co-pays, the consequences can be catastrophic.
“This is an important priority for our county. Greed has taken priority over the quality of life of our most vulnerable,” said Milan Balinton, Executive Director of African American Community Service Agency. “We need to make necessary medications like Epipen and insulin more accessible. The AACSA looks forward to supporting this initiative!”
As with insulin, the cost of both EpiPens and asthma inhalers has gone up dramatically. EpiPens can cost upwards of $650 for a package of just two injectors, and the generic version of the drug still costs $300. The price of asthma inhalers has increased similarly.
Fortunately, many residents either have insurance that covers all or most of the costs, or they have access to government programs that provide a similar subsidy. However, an increasing number of people with high-deductible insurance plans find themselves paying hundreds or thousands of dollars per month for the medications they need to keep alive. They are “the missing middle” of health care, unable to take advantage of government programs, but also without access to adequate health insurance.
“We know that deferred preventative measures lead to costly emergency room and inpatient care,” said Luisa Buada, Chief Executive Officer at Ravenswood Family Health Center. “Improving access to life-saving medications is vital for the wellbeing of our middle and low-income families and a prudent economic investment in public healthcare.”
“In addition to the obvious public health benefits, these programs will to some degree pay for themselves,” said Simitian. “Making it easier for individuals to access the medication they need will reduce costs across the board. It’s a case where an ounce of prevention is truly worth a pound of cure.”
Emergency room visits are one of the leading reasons for high healthcare costs in the County. “People go to the ER when they have nowhere else to go,” said Simitian. “Providing local residents with access to the medications they need to survive is one way we can both cut ER costs and save lives.”
Upon completion of the pilot program, County staff will present their findings to the County’s Health and Hospital Committee for follow up, and to consider the potential for the County to scale up the program and serve a greater number of residents. The report back is expected in 2021.
For more information visit:
January initial Simitian referral:
http://sccgov.iqm2.com/Citizens/FileOpen.aspx?Type=30&ID=146775
October HHC referral:
http://sccgov.iqm2.com/Citizens/FileOpen.aspx?Type=30&ID=155114