In his press to deliver Medicare for All, Bernie Sanders says the core problem with health care is that it produces enormous profits for insurance and drug companies.
"Last year the top 10 drug companies, for example, made $69 billion in profit," Sanders told CNN’s Brooke Baldwin April 30, "while one out of five Americans cannot afford the cost of prescription drugs when doctors prescribe medicine to them."
The Vermont senator and Democratic presidential candidate often brings up the unaffordability of drugs, and the one-in-five stat he used in his exchange with Baldwin was virtually identical to his words during his CNN town hall event a few days earlier.
As part of our ongoing effort to check health care talking points in the presidential election, we took a closer look at whether one out of five people can’t afford their prescription drugs.
• The most reliable data show that about 10% of people say the cost of drugs imposes a significant hardship.
• About 20% to 30% say that due to cost, they didn’t take a drug as the doctor recommended.
• About one out of three people use some strategy to reduce prescription drug costs, which includes asking their doctor for a cheaper drug.
Not all surveys are created equal. One of the most reliable is the government’s National Health Interview Survey. It reaches about 25,000 households and in 2017 it asked them how they tried to reduce the cost of their prescription drugs. About 11% said they did not take medications as prescribed. That could include not filling a prescription or stretching out one they had by not taking as much of the drug as they should.
If that’s the measure of affordability, then about one out of 10, not one out of five, can’t afford their medications.
But the survey revealed other strategies to cut costs that push the fraction higher. About 5% said they use alternative therapies, and nearly 20% said they ask their doctor for a cheaper drug.
Another well-regarded survey confirms the government results, and adds a few wrinkles that make it harder to draw simple conclusions.
The Kaiser Family Foundation, a reliable source of neutral health policy data, reported in February that 9% of respondents said it was very difficult to afford the cost of their prescription drugs.
But another 15% said it was difficult. This is based on prescription drug users. Out of all adults, 6% say it’s very difficult and 9% say it’s somewhat difficult to afford their medications.
These results highlight the ambiguities in Sanders’s statement. There’s no precise point where a drug becomes unaffordable.
"While having difficulty paying for medicine isn’t the same as not being able to afford it at all, it can be closely related and can lead to cost-related nonadherence — not taking the drugs as prescribed," Stacie Dusetzina, a health policy professor at Vanderbilt University, told us. "In some cases, this can be worse for people than not taking the drugs at all."
Dusetzina, and Sanders’ policy team, pointed to another part of the Kaiser survey that asked if people had not filled a prescription because of the cost. Nearly 20% answered, yes. Another 12% said they had skipped a dose or cut their pills in half.
"It is very hard to define affordability, especially for drugs," said University of Pittsburgh pharmacy professor Inmaculada Hernandez. "They are very important goods since they can save lives, so people may forgo use of other services or products to afford them."
Hernandez said that if people scrimp on basics such as food or clothing to pay for their drugs, that basically says that affordability is a significant problem.
On the other hand, the Kaiser survey data suggests that people might not see every prescription as vital to their health. Out of those who didn’t take a prescription as recommended, two thirds said their condition did not get worse.
The third survey comes from Gallup, which produced a report on behalf of West Health, a group focused on lowering health care costs for seniors. Gallup found that about 20% of people said that at some point in the past year, they had been "unable to pay for medicine or drugs" because they "didn’t have enough money to pay for them."
Looking at that and the Kaiser data, Stanford University health policy professor Michelle Mello said nearly 30% of people don’t take a prescription drug as recommended due to cost.
She said, "Sanders's estimate is on the low side."
Sanders said that one out of five people can’t afford their prescription drugs. There is some evidence for this. About 20% of people in a Kaiser survey said they had not filled a prescription because of the cost, and another 12% said they took less than the prescription called for.
But affordability is hard to measure. Only about 10 percent said it was very difficult to pay for their medications. Another 15% said it was difficult. These are subjective terms, and neither says that people went entirely without their medications.
The experts we reached said affordability is a significant issue. The survey data don’t precisely match up with Sanders’s words, but they support the idea that many people are pressed to pay for their medications.
We rate this claim Mostly True.