For Nicola Jackson, how to stretch her family’s tight budget often boils down to choosing between paying for the prescription drugs she needs to stave off head-splitting migraines or buying groceries. Medicare doesn’t cover all the costs for her medications to treat fibromyalgia, rheumatoid arthritis and nerve damage, leaving Jackson to scrape for dollars each month in her constant battle to afford prescription drugs.

“I know I still have a bill, but what am I going to do?” Jackson, a Cherokee County resident, said in a recent interview. “If it wasn’t for my faith, I tell you, sometimes it gets real tough.”

Jackson isn’t alone in her struggle to pay for prescription drugs in Georgia. Many residents are left to scratch and claw to cover out-of-pocket drug costs, all while having no clue as to why medication costs are on the rise. Georgia is among the highest-spending states in the U.S. when it comes to prescription drugs and out-of-pocket costs, according to national researchers:

• Georgia ranked 8th on overall medication spending in 2019 with nearly $14 billion in pharmacy retail sales, or roughly $1,300 per capita, an analysis by the nonprofit Kaiser Family Foundation shows.
  
• The state also ranked 4th in out-of-pocket drug spending at around $195 per person annually in 2018, the medication-assistance group NiceRx found.
  
• Gross costs for drugs under Medicare in Georgia soared from nearly $3 billion in 2013 to more than $5.6 billion in 2019, totaling more than the state’s share of current costs for Medicaid, according to State Affairs’ analysis of federal Centers for Medicare and Medicaid Services data.

While the numbers paint a clear picture of rising medication costs, the root causes for why drug prices have soared in recent years remain largely unknown, shielded behind certain carve-outs in state law and a complex system of behind-the-scenes price negotiations that many patient advocates blame for the rising costs. Even the full picture of how much Georgia spends on prescription drugs each year is incomplete, with one state agency failing to provide State Affairs with data on drug costs under Georgia’s Medicaid programs before this story was published.

Many key players in the medication distribution chain have pointed the finger at each other as the main driver behind rising costs, leading some advocates to declare that the whole system is rigged.

“Everybody’s hands are dirty,” said Barbara Adle, a retired nurse from DeKalb County who volunteers for a local senior-living advocacy group. “And the person who needs the drugs is the last person whose voice is heard.”

NEXT

Part II: A window into drug costs