美国国家公共电台 NPR When Insurers Don't Cover Drugs, Prescriptions Often Go Unfil

 

STEVE INSKEEP, HOST:

What happens when insurance companies deny coverage¹ for medications? It doesn't just force people to pay for drugs themselves; a survey finds that for almost half of Americans, when insurance denies payment, they do not get the drugs at all. The poll comes from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. NPR's Patti Neighmond reports.

PATTI NEIGHMOND, BYLINE²: Sally Radoci is 78 and on a fixed³ income. She has severe acid reflux.

SALLY RADOCI: I have to eat very small meals. And when I eat, sometimes it feels like everything is stuck in my chest, and I get really bad pain, and then I have to throw up.

NEIGHMOND: Radoci is retired⁴ and on Medicare. She also pays for a supplemental insurance policy to cover the cost of drugs, but it will only pay for the generic⁵ version of her heartburn medication. Her doctor prescribed the brand name. She says the generic version just doesn't work for her.

RADOCI: No, it's not as effective. No, definitely not.

NEIGHMOND: She can't afford the brand name, so now she has extremely painful episodes of acid reflux about three times a month. Our poll shows that, like Radoci, the vast majority of Americans have health insurance that includes prescription⁶ drug coverage, but 1 in 3 say that in the past year, insurance didn't cover the costs of medication for themselves or their household members. Robert Blendon with the Harvard Chan School directed our poll.

ROBERT BLENDON: So what you see is insurers are not paying for some drugs that physicians are recommending and the patients think they need.

NEIGHMOND: When that happened, most of the highest earners paid for the medication themselves. But Blendon says that was not the case for everyone else.

BLENDON: Half of the people who were middle class or moderate income are not getting them because they can't afford to go out and pay for it themselves.

NEIGHMOND: Bottom line, he says, it's just not fair.

BLENDON: This idea that if we save money, we all have to make tough choices together - the tough choices really don't affect the most wealthy people in the United States; they just affect people who are middle and lower income.

NEIGHMOND: And this could leave lower- and middle-income individuals more vulnerable to disease and other health problems. For Sally Radoci, one example is her EpiPen. She's allergic⁷ to bees and needs the EpiPen to inject life-saving medication in case she gets stung.

RADOCI: And the last time I was stung, the doctor said, each time you get stung can be very serious, and it can result in death. So he said, always carry the EpiPen. And in my case, I do a lot of gardening. And I'm by myself, so it just felt safe to have my EpiPen with me just in case.

NEIGHMOND: But this time, when she went to the pharmacy⁸ to get the EpiPen prescribed by her doctor, she was told her insurance wouldn't cover the cost.

RADOCI: It was close to $600. And I said, well, how about the generic? Could I get the generic? And she said, well, that's $398. And I said, you're kidding. She said no. I said, OK, then just forget it.

NEIGHMOND: So today, when Radoci gardens, she wears long sleeves and long pants to try to protect herself against bees. The situation, she says, is upsetting.

RADOCI: I have three insurances. I'm always paying a lot of copays. I pay a lot for my drugs. It's very frustrating⁹. I think when you have insurance, I think that you should be able to get the drug you need.

NEIGHMOND: One unexpected finding from our poll on income inequality is that even people who can afford to cover the cost of their medications sometimes don't. This is one of the first polls to survey the top 1%, people earning over $500,000 a year. And 18% of them chose not to fill prescriptions¹⁰ when insurance wouldn't cover it. Tina Smith is one of them. She runs a technology consulting firm in Minneapolis. Last year, when her doctor prescribed a medication to treat the skin condition rosacea, she got a shock.

TINA SMITH: When I went to fill the prescription, the cost for the prescription was over $600.

NEIGHMOND: She says for the past seven years, the medication cost about $20. So this was a huge increase, and Smith decided¹¹ not to get it.

SMITH: Because I felt that it was fiscally¹² irresponsible, and I have no interest in funding Big Pharma any more than I absolutely have to. I feel Big Pharma has been robbing the American people for years, and they continue to increase the costs of prescriptions.

FREDERICK ISASI: Drug prices have been escalating¹³ actually for, in a significant way, at least the last couple decades.

NEIGHMOND: Frederick Isasi is director of the consumer advocacy group Families USA.

ISASI: But in the last five or six years, it's really hit a crescendo¹⁴.

NEIGHMOND: Not surprisingly, the smallest increase were in generic drugs. But the adjective small, he says, pretty much ends there.

ISASI: You know, an average increase for drugs might be 15% or 16% annually¹⁵, which is, you know, much, much faster than our paychecks or inflation. But you could see a doubling or tripling of drug costs year over year, depending on the ability of that drug company to have no competition.

NEIGHMOND: He says health care costs are swallowing up more and more of family's discretionary income, not only in higher drug prices but also in higher deductibles, copays and cost-sharing. We spoke¹⁶ with representatives of both the pharmaceutical¹⁷ and health insurance industries, and they point the finger at each other. Insurers say the financial squeeze Americans are experiencing is because of high drug prices; the drugmakers say it's high insurance and hospital costs.

Whatever the reason, Harvard health economist¹⁸ and primary care physician Ben Sommers says not getting needed medication is not good news.

BENJAMIN SOMMERS: There's more and more evidence that having health insurance really does improve people's health and lives, and medications are one of the key parts of that because it is such a mainstay of how we manage a lot of chronic¹⁹ conditions.

NEIGHMOND: Now, Sommers says not all medications are equal.

SOMMERS: Some of the medications we prescribe are, really, kind of options to a patient. You say, look - this medication may help you feel better while you have this infection or while you are having some heartburn, but if you feel fine without it, that's OK.

NEIGHMOND: But others are critical - cholesterol²⁰-lowering statins, for example, or insulin to keep blood sugar under control.

SOMMERS: And sometimes people won't even notice they're not taking it. You know, not all these conditions have symptoms. You know, you can be building up dangerous levels of high blood sugar or cholesterol without noticing it until it's too late.

NEIGHMOND: Sadly, Sommers says he's not surprised by the findings of our poll. He says at least a quarter of his patients don't get new prescriptions filled because they say they just don't have the money. Patti Neighmond, NPR News.

(SOUNDBITE OF THE ALBUM LEAF'S "FALSE DAWN")

1 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

2 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

3 fixed   

adj.固定的，不变的，准备好的；(计算机)固定的

参考例句：

• Have you two fixed on a date for the wedding yet?你们俩选定婚期了吗？
• Once the aim is fixed,we should not change it arbitrarily.目标一旦确定，我们就不应该随意改变。

4 retired   

adj.隐退的，退休的，退役的

参考例句：

• The old man retired to the country for rest.这位老人下乡休息去了。
• Many retired people take up gardening as a hobby.许多退休的人都以从事园艺为嗜好。

5 generic   

adj.一般的，普通的，共有的

参考例句：

• I usually buy generic clothes instead of name brands.我通常买普通的衣服，不买名牌。
• The generic woman appears to have an extraordinary faculty for swallowing the individual.一般妇女在婚后似乎有特别突出的抑制个性的能力。

6 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

7 allergic   

adj.过敏的，变态的

参考例句：

• Alice is allergic to the fur of cats.艾丽斯对猫的皮毛过敏。
• Many people are allergic to airborne pollutants such as pollen.许多人对空气传播的污染物过敏，比如花粉。

8 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

9 frustrating   

adj.产生挫折的，使人沮丧的，令人泄气的v.使不成功( frustrate的现在分词 )；挫败；使受挫折；令人沮丧

参考例句：

• It's frustrating to have to wait so long. 要等这么长时间，真令人懊恼。
• It was a demeaning and ultimately frustrating experience. 那是一次有失颜面并且令人沮丧至极的经历。 来自《简明英汉词典》

10 prescriptions   

药( prescription的名词复数 )； 处方； 开处方； 计划

参考例句：

• The hospital of traditional Chinese medicine installed a computer to fill prescriptions. 中医医院装上了电子计算机来抓药。
• Her main job was filling the doctor's prescriptions. 她的主要工作就是给大夫开的药方配药。

11 decided   

adj.决定了的，坚决的；明显的，明确的

参考例句：

• This gave them a decided advantage over their opponents.这使他们比对手具有明显的优势。
• There is a decided difference between British and Chinese way of greeting.英国人和中国人打招呼的方式有很明显的区别。

12 fiscally   

在国库方面，财政上，在国库岁入方面

参考例句：

• Nor will fiscally stretched governments pump more money into the political equivalent of a leper colony. 财政吃紧的政府也不愿将更多的钱投入这个避之唯恐不及的政治瘟疫区。
• We are more fiscally constrained, which forces us to work smarter and more efficiently. 与F-15相比我们资金上的限制更大了，美女类小游戏，这迫使我们更为精心和有效地工作。

13 escalating   

v.（使）逐步升级( escalate的现在分词 )；（使）逐步扩大；（使）更高；（使）更大

参考例句：

• The cost of living is escalating. 生活费用在迅速上涨。 来自《简明英汉词典》
• The cost of living is escalating in the country. 这个国家的生活费用在上涨。 来自辞典例句

14 crescendo   

n.(音乐)渐强，高潮

参考例句：

• The gale reached its crescendo in the evening.狂风在晚上达到高潮。
• There was a crescendo of parliamentary and press criticism.来自议会和新闻界的批评越来越多。

15 annually   

adv.一年一次，每年

参考例句：

• Many migratory birds visit this lake annually.许多候鸟每年到这个湖上作短期逗留。
• They celebrate their wedding anniversary annually.他们每年庆祝一番结婚纪念日。

16 spoke   

n.（车轮的）辐条；轮辐；破坏某人的计划；阻挠某人的行动 v.讲，谈（speak的过去式）；说；演说；从某种观点来说

参考例句：

• They sourced the spoke nuts from our company.他们的轮辐螺帽是从我们公司获得的。
• The spokes of a wheel are the bars that connect the outer ring to the centre.辐条是轮子上连接外圈与中心的条棒。

17 pharmaceutical   

adj.药学的，药物的；药用的，药剂师的

参考例句：

• She has donated money to establish a pharmaceutical laboratory.她捐款成立了一个药剂实验室。
• We are engaged in a legal tussle with a large pharmaceutical company.我们正同一家大制药公司闹法律纠纷。

18 economist   

n.经济学家，经济专家，节俭的人

参考例句：

• He cast a professional economist's eyes on the problem.他以经济学行家的眼光审视这个问题。
• He's an economist who thinks he knows all the answers.他是个经济学家，自以为什么都懂。

19 chronic   

adj.(疾病)长期未愈的，慢性的；极坏的

参考例句：

• Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
• Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。

20 cholesterol   

n.（U）胆固醇

参考例句：

• There is cholesterol in the cell of body.人体细胞里有胆固醇。
• They are determining the serum-protein and cholesterol levels.他们正在测定血清蛋白和胆固醇的浓度。