Costs

The most common cost mentioned by people with severe asthma was asthma medicines, which participants perceived to be expensive. The main other cost was visits to doctors. Australian research shows that cost is a significant factor in people’s decisions about asthma medicines [Davis et al 2019]. People with severe asthma talked about what out-of-pocket costs needed to be met, and the balance between the cost of their medicines and achieving their best possible lifestyle.

There was a range of situations regarding payment for medicines overall. Most people with severe asthma received some kind of assistance, be it a healthcare card (for example if they had an aged or disability pension) that would reduce the cost of prescriptions by up to 85%, or reaching the Medicare safety net, which would reduce the cost of prescriptions for the rest of the calendar year. Biologic therapies for severe asthma are heavily subsidised by the government for people who meet certain criteria. However, even though individual medicines were inexpensive, people with severe asthma were often prescribed several different asthma medicines, which added up. In addition, some medicines were necessary to deal with side effects of asthma medicines, such as Vitamin D and calcium when on oral steroid tablets. Some participants were fully aware that it would be a different story if they had to pay the full price of the medicines.

Clive would not be able to afford the full price of the biologic therapy.

Shannon finds it hard to afford her medicines and has had to ask her mother for help to pay.

Not all participants were able to access concessional rates for medicines.  Some continued to work, noting that workers compensation wasn’t going to pay, or they had private health insurance or had cashed in their superannuation. It should be noted that in Australia almost all medicines are subsidised by the Australian government to a maximum of $40.30 per prescription, and that for patients on a low income, there is an additional subsidy down to $6.50 per prescription.

For Tony the cost of medicines has added up over time.

Participants found that the price of their reliever inhalers varied depending on the type of pharmacy they went to, and that preventer inhalers were more expensive than relievers. Preventer affordability also depended on how the medicine was prescribed, that is how many puffs and what strength. However, it was not just the medicines themselves that people with severe asthma had to pay for. There could be other items such as nebulisers, filters and masks, and these needed to be changed regularly. One participant had purchased an air purifier which cost $2500.

Michael explains about price variation for reliever inhalers.

Lauren has taken healthcare providers to task over the cost per dose of her inhalers.

Australian research suggests that doctors do not discuss cost of asthma medicines with their patients. People in this study had varying experiences in this regard. Some found their specialist actually considered medicine cost, but others were critical of healthcare providers’ knowledge and practice in this area:

Justin was pleased with his specialist’s knowledge about costs.

Lauren doesn’t think healthcare providers think about the cost implications

People with severe asthma sometimes found themselves having to decide whether they could afford their medicines with the money available to them. For some that meant choosing between different types of medicine and considering not filling their asthma medicine script. Others felt they would always find a way to afford their asthma medicine as it improved their quality of life. Some people we interviewed felt guilty spending money on medicines rather than other items. Some pharmacies had organised an account so the person with severe asthma could pay as they were able. People we talked to also mentioned that their ability to pay varied across time; for example things were more difficult when their children were young.

Jemma has had to think about which medicines to go without.

Diana felt guilty spending money on medicine.

Lauren isn’t convinced her quality of life is worth twice the medicine cost.

Jemma appreciates paying the charges off as she is able.

There were other costs apart from medicines for people with severe asthma such as visits to doctors, and services provided in the person’s home such as cleaning. As people with severe asthma often have lots of issues to discuss, they may have to pay for longer consultations with doctors. Some people were paying a great deal to see their specialist, but others had discovered that to see a specialist in a hospital clinic was free including any tests needed.

John B sees time as an issue.

Marion attends a free clinic now.

* The Safety Net is a yearly threshold which when reached means that concession card holders receive any further medicines at no cost.

 

References:

  1. Davis SR, Tudball J, Flynn A, Lembke K, Zwar N, Reddel HK. "You've got to breathe, you know" - asthma patients and carers' perceptions around purchase and use of asthma preventer medicines. Aust N Z J Public Health. 2019.