Health Insurance HQ: An Update on the Health Care Landscape | Entertainment Community Fund

Health Insurance HQ: An Update on the Health Care Landscape

Welcome to Health Insurance HQ—coming to you from the experts at The Actors Fund's Artists Health Insurance Resource Center and special guests!

Dear Friends,

Americans have a complicated relationship with pharmaceutical companies. Rising costs and price gouging appear to be at an all-time high. Among adults who currently take a prescription drug, 24 percent report difficulty affording their medication. However, these companies also put money into research that produces drugs that have saved, lengthened and enhanced the quality of millions of lives.

So why are drugs so expensive? Mainly, because drug companies can charge whatever they want. There are no federal rules or laws that regulate what a drug costs. Drug companies say that they price drugs on a number factors, including the expense involved in developing it. Research shows, however, that they spend up to twice as much on marketing their products than they do on research and development.

What are some things that you can do as a consumer to lower your drug costs?

Have a conversation with your doctor
If you’re having trouble affording your prescription, let your provider know so you can work together to find an alternative that works for you. Ask your doctor if a generic drug would be appropriate. Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug.  They are chemically identical but have not had the same costs associated with them, and are usually less expensive to the consumer.

Shop Around
If you pay out of pocket, check out the website GoodRx where you can compare prices at various local pharmacies. You will see how prices vary for the same medication, and you’ll probably be quite surprised at the range! Good RX also offers a discount card for medications.

Co-pays or medications too expensive?
Check out Rx Outreach, a non-profit pharmacy. If you meet income eligibility requirements, you can get a 90 day supply of many medications for $20.

Uninsured?
Go onto NeedyMeds, where you can find out if your medication has a pharmaceutical assistance program. If you are uninsured, or your insurance does not cover your medication and you meet certain eligibility requirements, you may receive free or low-cost medications through the drug manufacturer. Needymeds also offers a discount card.

What are legislators doing to lower drug costs?
The 116th Congress has introduced several drug pricing proposals to aggressively fight the rising cost of drugs.
The top three include:

  • Permitting the Secretary of Health and Human Services to be able to negotiate prices for Medicare medications.
  • Allow Americans to import lower-priced drugs from abroad and connect the price of prescription drugs in the United States to median drug prices in five countries – Canada, the United Kingdom, France, Germany, and Spain.
  • Open up generic competition to patent-protected United States brand-name drugs that are considered “excessively priced.”

You can follow all Federal policy proposals on the Drug Pricing Lab website.

Legislators are also looking to Canada to help fix our high costs. Vermont has become the first state in the nation to approve prescription drug importation from Canada.  Several steps remain before the Vermont program would take effect. Other states, including Colorado and Utah, are also introducing similar legislation. To find out what’s happening in your state, check out National Academy for State Health Policy to keep up with current legislation.

It is thought that states and their consumers will reap large savings by paying Canadian prices. For example, Lyrica costs $6.04 in the United States and 63 cents in Canada, and Xarelto cost $12.44 here compared to $2.11 in Canada.

But there are detractors to this solution. Unsurprisingly, pharmaceutical companies are not in favor of importing from Canada, and there are concerns that prices will go up for Canadians, creating a shortage as they struggle to keep medications affordable. Indeed, prices in Canada are currently trending up. More than 900,000 Canadians reduced their spending on basic necessities like food and heat to pay for prescription drugs in 2016.

A majority of Republicans, Democrats and Independents favor policies that reduce costs. We can all work together to:

  • Fight for price transparency
  • Approve more generic versions of common drugs, making them easier to come onto the market.
  • Allow importation of drugs from legitimate Canadian and European sources
  • Set limits on consumers out of pocket costs
  • Allow the federal government to negotiate with drug companies to lower the price on medications for those on Medicare

Contact your elected officials to let them know what measures you support.

Yours in good health,


Janet Pearl
Health Services Manager, Health Insurance Resource Center

Do you work in performing arts and entertainment and have questions about health insurance? The Actors Fund provides assistance nationally. Contact our regional office closest to you to speak to a counselor.

New York City
917.281.5975

Los Angeles
855.491.3357

Don’t forget to use the resources section of our website. It contains tools to help you make decisions about your health insurance, including new online tutorials on how to choose providers and how to read an Explanation of Benefits. In addition, you’ll find an updated Stage Managers National Health Directory, our national online directory of health care providers recommended by industry professionals that can be used by theaters and touring companies. For these resources and more, visit actorsfund.org/HealthServices. You can also find out more about enrollment assistance and upcoming health insurance seminars near you!