When President Donald Trump announced ‘TrumpRx’ in early February, a weight I’ve carried my entire adult life suddenly lifted from my shoulders. The website offers life-saving medications at much lower prices than normal, based on the president’s promise to give Americans the same prescription drug costs as patients in other developed countries. I can personally attest that such equal treatment — a policy known as ‘most favored nation’ pricing — is urgently needed for people who struggle with chronic disease.
I’ve had debilitating asthma since I was a child. I’ve been able to manage it thanks to a prescription drug which blocks lung inflammation and keeps my airways open. The few times I’ve gone off the medication, I’ve ended up in the emergency room, unable to breathe. That nearly happened four years ago in what I thought was the worst possible place — on the other side of the world, unable to contact my doctors or go to my pharmacy.
My family and I were in Italy, on a trip to honor my mother. She had recently been diagnosed with cancer and my brother and I scheduled the trip in between her chemo treatments, when she would be well enough to travel. She had always wanted to go there with us. But in our rush to get two families and three little kids packed, I accidentally grabbed a nearly empty inhaler.
I realized my mistake a few days into the trip, when I looked at the inhaler and saw that I only had two doses left. I wasn’t just worried about my health, though, of course, that was paramount. I worried how I’d afford the drug if I even found it in Italy.
I’ve organized my professional life around access to insurance that covers my medication, given its longstanding retail price $600 for a month’s supply. For 25 years, I’ve grappled with denied coverage letters, premium tier prescription charts and the constant worry that we would have to cut back on necessities to get my medication. At the time, in Italy, I was already paying a few hundred dollars a month for the drug — a lot, but a bargain compared to its normal price.
But I had no choice. I had to get my medication. After a few minutes of searching, I found an Italian pharmacy across town. I walked there immediately, trying to control my racing thoughts of what might happen. I knew that if I couldn’t get the drug, I couldn’t get safely back to the U.S.
Fifteen minutes later, in tears I walked out, drug in hand. It cost me only 30 euros or about $35.
At first, I was both relieved and grateful. But by the end of the day, I was scratching my head. Why was it $600 in the U.S. while Italians could get it for next to nothing? In the days that followed, I discovered that the answer is beyond complicated.
It’s affected by everything from a lack of price transparency to the meddling of middlemen who jack up costs. It’s also true that foreign countries have been negotiating the prices of prescription drugs for decades, forcing Americans to cover the enormous cost of pharmaceutical development while they pay far below market prices.
Whatever the reason, the system doesn’t work for Americans. Brand name prescription prices in the U.S. are more than four times higher than prices in other wealthy countries. As many as 18 million Americans have struggled to buy the prescriptions they need in recent years.
I’m now using a generic version of the drug that costs significantly less. But that doesn’t change the fact that I, like many other Americans with chronic disease, have paid through the nose for decades on end, only to find the medication I needed in Italy for what seemed like pennies.
I wasn’t just worried about my health, though, of course, that was paramount. I worried how I’d afford the drug if I even found it in Italy.
