Out-of-Pocket Spending for Retail Prescribed Drugs by Age and Type of Prescription Drug Coverage

Increasing use of new, expensive specialty drugs and sharp price increases for some existing drugs have led to concerns about high, and rising, out-of-pocket costs for prescription drugs. Two measures from nationally representative data, however, suggest that in recent years overall affordability of retail prescription drugs has not deteriorated, and may have improved.

Out-of-Pocket Spending for Retail Prescribed Drugs by Age and Type of Prescription Drug Coverage, a statistical brief from the Medical Expenditure Panel Survey, examines the distribution of out-of-pocket spending for drugs purchased or obtained in an outpatient setting.

Highlights

• From 2009 to 2018, median annual out-of-pocket spending per user on retail drugs fell from $93 to $54. At the 95th percentile of the distribution, out-of-pocket spending fell from $1,369 in 2009 to $945 in 2018.
• Among non-elderly individuals, median annual out-of-pocket spending per user for retail drugs fell from 2009 to 2018 for the privately insured ($90 to $48) and the publicly insured ($4 to $1).
• At the 95th percentile of the distribution, annual out-of-pocket spending per user on retail drugs among uninsured non-elderly individuals was $1,620 in 2018 and was not significantly different from 2009.
• Among elderly adults who obtained retail prescription drugs, median annual out-of-pocket spending fell from 2009 to 2018 for those covered by private drug insurance ($361 to $154), for those covered by Medicare Part D ($341 to $160), and for those with no drug coverage ($318 to $177).
• At the 95th percentile of the distribution, annual out-of-pocket spending per user for elderly adults with no drug coverage fell from $3,051 in 2009 to $1,624 in 2018. 

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