Part III: Choosing drugs over groceries

Credit: iStock

Aug 25, 2021
Key Points
  • Medicare prescription-drugs have skyrocketed 89% in Georgia from 2013 to 2019.
  • Prices for common medications in Georgia have also ballooned during that time.
  • Cost transparency is lacking even from state government as key prescription-drug players blame each other.

While Medicare data hint at rising medication costs across the board in Georgia, research by NiceRx shows prices for many high-demand prescription drugs have also ballooned – including for several drugs that Jackson needs. Jackson said she takes the brand-name drugs Lyrica and Trulicity to help keep her migraines and Type 2 diabetes in check. NiceRx’s findings show average prices for both drugs shot up between 2012 and 2017:

  • 137% increase for Lyrica: from $174 per fill to $411
  • 35% increase for Trulicity: from $497 per fill to $674

Other common prescription drugs in Georgia have also rocketed up in price. The American Association of Retired Persons (AARP) Georgia chapter estimates the cancer drug Revlimid shot up from an average of roughly $185,500 per year in 2015 to nearly $270,000 in 2020. A 2020 congressional report traced Revlimid’s steep price hikes to a desire by executives for its manufacturer, the New Jersey-based drugmaker Celgene, to “meet company revenue targets and shareholder earnings goals.”

Similar price spikes have been seen for common drugs that treat diabetes, asthma and chronic obstructive pulmonary disease, according to the AARP’s findings. Medicare and other health plans cover most prescription drug costs to keep them affordable. However, many low-income Georgia residents and seniors on fixed incomes still struggle to make up the difference for what’s not covered, said Nancy Pitra, AARP’s Georgia associate state advocacy director.

“They’re having to pick and choose between paying for medications and buying groceries,” Pitra said in a recent interview. “That’s not living at all.”

Prescription drugs infographic
Costs for prescription drugs under Medicare throughout the U.S. increased between 2013 and 2019.
(Credit: Brittney Phan for State Affairs)

Sometimes, even local Medicare providers decline to cover certain drugs that doctors insist their patients need. Decatur resident Alex Roetger has butted heads with his Medicare provider over an inhaler made in Germany called Spiolito Respimat that his doctor prescribed for respiratory issues but which he said comes with a price tag of $500 every other week.

The inhaler has worked wonders in the year or so since Roetger began losing his voice, and it doesn't contain steroids that “tear my lungs apart,” he said. But while his Medicare provider covers costs for some inhalers, Roetger said it won’t pick up the bill for the one his doctor prescribed.

On top of other medications he takes for high blood pressure, Roetger said he can’t afford to add a $12,000 annual tab for the inhaler to his budget in retirement. He’s now waiting to see if any outside groups will help whittle down the costs. Until then, Roetger expects he’ll need to ration the free inhaler samples that his doctor gave until they all run out.

“What I’ll do is what every other senior does: I’ll cut the dosage in half,” Roetger said in a recent interview. “Then a third, then a quarter. Then you just give up.”

Roetger is among many seniors and low-income Georgia residents who rely on outside help from groups like GoodRx to subsidize their drug costs. Some drug companies also offer grants to cover costs, such as for the brand-name drug Enbrel that Jackson takes for rheumatoid arthritis. The need for many Georgia seniors to lean on outside funding to pay for medications when they already have health insurance frustrates local advocates like Ellen Miller-Mapp, a member of the senior advocacy group LeadingAge Georgia.

“It’s falling to the end consumer to go through complicated choices to get relief,” Miller-Mapp said in a recent interview. “As a country, we just have not done well by our seniors. There’s just no other way to put it.”

Doctors in Georgia have also seen cash-strapped patients delay filling their prescriptions or ration what drugs they have to make ends meet. State and federal lawmakers need to double-up efforts on passing regulations to clear away transparency hurdles that hurt patients, said Tom Kornegay, a spokesman for the Medical Association of Georgia.

“Patients delay, forgo or ration their medication when treatments are cost prohibitive – which undermines their health,” Kornegay said in a recent statement. “(We believe) that the best way to reduce health care costs is to reduce the massive administrative burdens that don’t have anything to do with patient care, including billing.”


Part IV: Prescription drug blame game