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By State Representative Christine Barber

Auri is a single mother living in Salem, Massachusetts who pays over $800 per month for a health insurance premium through her employer to cover herself and her two children. On top of that premium, Auri also pays hundreds of dollars a month in co-pays and other costs for medications and specialist visits related to chronic health issues, including asthma. For her asthma, Auri needs four different inhalers which cost about $40 for each prescription. These health costs—which compete with other family expenses like food, utility bills, and her mortgage—leave Auri worried she won’t be able to afford her life-saving medications each month.

Auri is not unique to this situation; countless residents in Massachusetts experience similar struggles to access the medication they need in order to survive and stay healthy. The Health Policy Commission recently reported a 60% increase in monthly prescription drug costs for chronic conditions over the past 5 years. While the COVID pandemic exposed just how vulnerable many in our communities are, particularly for people with chronic conditions, these challenges continue to exist and are even worse now. Historically in Massachusetts, like other states, communities of color have experienced higher rates of chronic diseases. Research shows that disparities in the health care system stem from the legacy and continued effects of racism in our country.

Our neighbors should not have to choose between picking up their prescription and picking up groceries.  There is now an opportunity to build upon what we have learned and improve the system.

I recently introduced H.943 in the Massachusetts House of Representatives, An act to reduce co-pays for people with chronic conditions, to help families afford prescriptions for basic health needs. This bill would reduce cost-sharing, including co-pays for people with three chronic conditions that disproportionately impact people of color and low-income communities: diabetes, asthma, and heart disease. For generic medication for each of these three conditions, all cost-sharing will be eliminated. For a brand name medication for these conditions, including insulin, coinsurance and a deductible will be eliminated and co-pays will be capped at $25.

Co-pays and cost sharing are both primary reasons why people do not access the care they need. Twenty-five percent of Massachusetts residents WITH health insurance still have unmet health needs, and a portion of this is due to unaffordable prescription drugs. In a recent study, when asked the reason for not getting health needs met, most insured residents referred to issues in coverage or cost. Over a third (35%) said that the co-pay or coinsurance was too high, or that they would have to pay for their care as part of their plan’s deductible (24%). When it comes to chronic conditions, this leads to worse health. People need these medications to survive, and taking insulin or an asthma inhaler should not compromise their families’ other needs.

Inability to afford prescriptions can greatly limit access to health care. When people cannot access critical preventive care, the likelihood of visiting the emergency room for care increases drastically. Compared to White residents (11.2%), Black residents were nearly twice as likely, and Hispanic residents nearly three times as likely, to have a potential reliance on the ER for care (20.0% and 29.1%, respectively). As recently outlined in a recent report by the Blue Cross Blue Shield of Massachusetts Foundation, the economic burden of health disparities in Massachusetts costs us nearly $6 billion each year in avoidable health care costs, lost labor and productivity, and premature illness and death. 

The Act to Reduce Co-Pays bill is one way to focus on health equity to provide direct relief to patients. The core goal of this legislation is to lower the costs of prescriptions so people can avoid more costly care later, and is one key to eradicating inequitable health care access in Massachusetts. While we continue to address these complex challenges on a number of fronts, this is one important step to supporting preventative care in our communities.

Community members in Somerville and Medford, as well as throughout the state would be better able to afford health care through this legislation. We have an opportunity now to take a step towards health equity, and for Massachusetts to continue to be a national leader in health care access.