Opinion: San Diegans with mental health problems are turning away from treatment because of high costs

Pharmacy customer
A customer walks down the aisle of a pharmacy. Photo by Mark Bukawicki via Wikimedia Commons

Rising health care costs continue to put treatment out of reach for vulnerable communities in San Diego and across California, including many people living with mental health issues. Healthcare providers are reporting increases in anxiety, depression and addiction due to the COVID-19 pandemic, economic fears, job losses, rising costs of living and many other factors.

Without significant efforts to address health care costs—and specifically what San Diego patients pay at the pharmacy counter—we risk exacerbating a health care crisis as patients delay or forego treatment altogether.

A growing body of evidence suggests that the impact of heavy health care costs is already negatively impacting the mental health of California patients and their families. A 2021 California Health Care Foundation survey found that more than half of Californians have skipped or delayed mental and physical health care because of cost.

And according to a survey by the Kaiser Family Foundation, 57% of Californians report that they cannot access the behavioral health care they need.

California policymakers have made attempts over the years to improve what patients pay out-of-pocket for their drugs, including through reform of the prescription drug rebate system. This year, Senate Bill 1361 would have increased transparency into the opaque business practices of pharmacy benefit managers (PBMs) and required 90 percent of manufacturers’ rebates to be passed on to consumers at the pharmacy counter.

Health insurance companies and PBMs negotiate significant rebates and discounts when purchasing drugs from drug manufacturers. The price they pay after rebates is less than the “list price” of the drug. On average, pharmaceutical manufacturers make a discount of 40% from the list price of the drug.

In 2020, the Department of Managed Health Care reported that health plans received more than $1.4 billion in rebates, a 57% increase from 2017. Due to a lack of transparency and accountability, nothing requires health plans to guarantee , that patients will benefit from these discounts.

Passage of SB 1361 would help reduce patients’ out-of-pocket costs for prescription drugs and help increase adherence to their medication regimens. Unfortunately, California lawmakers have once again failed to reform the byzantine system of drug pricing and rebates that health insurance and pharmacy middlemen use to dump profits on the backs of patients.

According to the San Diego County Health and Human Services Agency, about 1 in 4 adults in San Diego County faces a mental health challenge. Nationally, 1 in 5 adults suffer from a mental illness and 1 in 20 experience a serious mental illness, according to the National Alliance on Mental Illness.

Patients living with mental illness face a number of obstacles to successful treatment of their conditions, including persistent stigma surrounding mental illness and barriers to proper diagnosis. Managing mental health conditions often requires a range of treatments and a challenging process of trial and error to find which treatment regimen works best for the individual patient.

Once a doctor and patient find an effective treatment or combination of treatments, patients must determine whether or not the treatments are covered by their insurer. After all, the cost of treatment should never be a barrier to accessing care, and it should never be a reason for someone to drop out of treatment.

We urge lawmakers to prioritize sensible prescription drug cost policies that would reform the current PBM rebate system and help reduce the cost patients pay over the counter for their drugs. For some Californians, it’s a matter of life and death.

Catherine Nacario is the executive director of the National Alliance on Mental Illness in San Diego and Imperial Counties.

Leave a Comment

Your email address will not be published.