I grew up in the suburbs of a declining manufacturing town. We are often referred to as living in the rust belt here in Cleveland. We have had some highlights. I’m guessing most of you have heard of LeBron James (to be fair, he’s NOT from Cleveland, but most here like to claim him) and another almost-winning team, the Cleveland Indians. However, jobs are still not what they were in the heyday of steel production. While my family struggled with unemployment when we were younger, we still had it good. We were privileged, and didn’t want for the basics. Drive ten minutes to the west of us and it was a different story. It was back then and it still is now (perhaps even more so).
Allergies and asthma have many costs to consider. In my last piece, I spoke about the differences in the cost of food. Being a medical condition, there are many other financial burdens one needs to think about.
Medical care costs are going to depend on whether there is medical coverage and how much it covers, whether deductibles have been met, and so on. The cost of paying out-of-pocket can vary greatly depending on the facility you go to, where you are located, even what insurance you carry, but can cost anywhere from $200-600 (I have heard/seen figures all over the place). People with allergies need to see a BOARD CERTIFIED ALLERGIST, which incurs a higher price as well. Testing is typically done, and comes in two forms. Skin-prick testing is done in-office. Oftentimes blood work is also done, and that would most likely be done elsewhere. The blood testing, depending on the extent of what is tested, can cost anywhere from $1000-3000 (when paying out-of-pocket).
Now that you are $1200-3600 into things, and your history and testing have confirmed allergies, you are given a prescription for an epinephrine auto injector. I’m sure you have heard of the what these cost. There are several options out there currently, ranging in price from about $100 to $4500 cash price (there are programs to help which you can find more about here). These auto injectors have roughly a 12 to 18-month life (depending on the supply chain — ALWAYS check your auto injectors when picking them up from the pharmacy to be sure you have at least 12 months before they expire!) What this means is that if you don’t have to use them (which we all hope for) you will still need to replace them in 12-18 months. Now, $110 may not seem like much but the reality is, for those who are living paycheck to paycheck, replacing those may not be an option. Many families have to choose between food, housing, utilities, and life-saving medications.
Let that sink in. This isn’t a medication you can fill “if you need to eventually.” This is LIFE INSURANCE at the highest degree.
If there is an incident and you have to give epinephrine, you need to go to the hospital, and in a hurry. This isn’t because it is itself dangerous (it’s a very safe medication in fact), but because there may be a need for more medication. There is also the risk of something called a bi-phasic reaction, where there is a secondary reaction, even several hours after the initial one. It can cost up to a few thousand dollars for this, and many times you will also receive a bill from emergency services. Next, you will need to replace the used device.
Taking time off of work is something many just cannot do. The loss of productivity for a family, some of which are single-parent families, can be devastating. Many people today struggle to make it, even with two parents earning incomes, or with multiple jobs. Taking time off to get to the doctor for all of the above is very difficult, and if there is a hospitalization, the impact is even more devastating. Transportation to and from doctor appointments may require extended time away from work if needing to take public transportation. Simply getting there is costing families time and money which many do not have, especially in underserved communities.
There are many parents who are walking around with expired devices because they simply can’t afford to replace them. I heard a statistic once that something like 80% of epinephrine prescriptions are not even filled! THAT was mind-blowing to me. I stepped back and asked “why in the world?” and then realized there are many reasons why. Sometimes it is a lack of education, and people do not understand that epinephrine is the first line of defense in an anaphylactic reaction. That should be covered with the doctor before a patient leaves. The more pressing issue is affordability. There has been a lot of shakeup in the community over the past year regarding this. There have been new brands and pricing schemes coming to market as well, which is a great thing to hopefully bring the prices down over time so they are more likely to be filled when prescribed.
These stories are the same for those with asthma. Do you know the reason for the most missed school days is because of asthma? I think we can all agree that breathing is pretty important to, well, life. The rates of asthma in the inner cities is very high, and these kids often don’t have sufficient access to the help they need to be well. Asthma medications are not any cheaper than epinephrine, and many patients are on multiple prescriptions, so the finances are similar.
I can call my child’s doctor and have a new prescription in my hand in roughly 24 hours, if everything is in working order. I can get in my car and be at the pharmacy in less than 5 minutes, and I know how very fortunate I am to be able to do this. Same if my kid does need to get to the doctor or the lab. I’m wondering what we can do as an allergy community for those who don’t have the access we do. The rates of asthma in cities is horrendous, and the education needed to manage it (as well as allergies) is something we need to think about. I realize so many of us are fighting for our own kids, for a cure, or for rights at school. I worry about those things too, but I am deeply troubled about those who are so busy trying to manage life in general, that health issues aren’t able to be managed on many fronts.
You can read the first installment, Food Allergy Economics 101 here.