October 28, 2013 | Posted By Jane Jankowski, LMSW, MS

With contentious changes afoot in the US healthcare system these days, one old problem seems to be gaining important attention as the public reflects on what will change with the advent of the Affordable Care Act. The cost of prescription medications is often so high; patients are forced to make tough choices in order to maintain their health without going broke. This topic was front page news in the New York Times (New York Times October 2013 ) this month where the focus was on escalating costs of asthma drugs. Compared to other nations, the expense of many common – and even not so common – medications is dramatically higher for consumers in the US. This is hardly news, and studies have been done showing that senior citizens were historically the hardest hit by medication costs given the intersection of age related health problems and fixed incomes with no prescription benefits. Though somewhat ameliorated when Medicare D was added, not all of the medication problems are resolved, particularly when an individual requires skilled nursing care in a nursing home (Medicare D and Nursing Home Residents.)

Nursing Homes typically receive a fixed rate per month per resident which covers room, meals, skilled care, medications, and all general services the resident needs on a daily basis (Skilled Nursing Facilities Info .) When considering whether or not to admit a patient for the first time, the cost of the patient’s medications is factored into the overall application for admission. If a patient’s medication regimen is too costly, that individual will likely be denied by the facility. For patients seeking nursing home placement from an inpatient hospital setting, the side effect of this medication cost calculation is potentially a prolonged hospital stay. When a patient is too fragile to remain home in an unsupervised setting, yet no longer acutely ill, the allocation of a hospital bed for the purposes of custodial care is inappropriate. Not only is this bed unavailable for patients who are acutely ill, the patient is at risk of contracting hospital borne illnesses simply by virtue of hanging around a place where really sick people are being treated.

Gaining control of these kinds of barriers to moving patients to an appropriate level of care will require an overhaul of how medication pricing is determined. Though the free market method leaves too many patients stranded. Controlling costs up front by ensuring medications are priced within fair limits will help not only nursing home bound patients but also provide some relief to others facing the strain of prescription medication costs. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.