Seventy-three-year-old Leonard L. Edloe, a pharmacist of 50 years and pastor of a predominately Black church in Middlesex County, Va., knows the personal and professional sides of heart disease, stroke, and diabetes well. He also knows the astronomical costs of prescription medications and the related financial struggles.
His father—also named Leonard L. Edloe—opened the first of their four family-owned pharmacies in 1948. But he was only 65 when he came home from work one day, sat down, had a sandwich and a beer and then died of a massive heart attack. It was a major emotional blow to lose his father and mentor that way. But then Edloe's sister died at 60 and his brother at 54 - also both of heart attacks.
"I had to get out," he said sternly, reflecting on his now determined self-care through exercise and healthy eating. "I'm 73 now."
For decades, Edloe has been a prominent household family name in Richmond, Va. where his father's first pharmacy was established. Since his family was upper middle class, he acknowledged they had no problem paying for prescription medication. But given his father's legacy and his own community service through his profession and dedication to help people in need, he is known for being on the cutting edge of the struggle to establish health equity. That includes exploring ways to make prescription drugs more affordable and accessible to all.
"The pricing has gone through the roof," he said in an interview. "I mean, insulin - a month's supply for some people - is $600." That's $7,200 a year. "Even the generic pricing has gone up," he points out. “That has become worse because so many of the drugs are imported. Seventy-five percent of the drugs in the United States have an ingredient that's made in China, India or Germany."
Edloe explained that "Because there's no control over pricing in the United States, they can basically charge what they want to; whereas in other countries, the government decides."
As a former long-time member of Medicaid HMO Virginia Premier Health Plan's board – Edloe pointed out that the drug used to treat Hepatitis C costs $1,000 a pill. But in Egypt, it is $1 a pill.
Edloe has expressed these concerns vehemently over the years in various leadership roles, including as chair of the Virginia Heart Association for the Mid-Atlantic Region; president of the American Pharmacists Association Foundation, and board member of the Virginia Commonwealth University Health Systems Authority.
"My blood pressure medicine for myself has tripled in price. I was paying $15 for three months. Now it's $45," he said. "Fortunately, that's with my insurance."
For people who lack health insurance, medicine for hypertension can cost upwards of $300-$600 a year, which, can be difficult to manage financially along with paying for other medications and bills. "So, it's real serious," Edloe concluded.
Community health workers and researchers around the country have long recognized the increasing costs of prescription drugs and the difficult choices some people must make to afford them.
An article in Harvard Medical School's Harvard Health Publishing, titled, "Millions of Adults Skip Medications Due to Their High Costs” highlights findings from a national survey conducted by the Center for Disease Control and Prevention’s National Center for Health Statistics:
Eight percent of adult Americans don’t take their medicines as prescribed because they can not afford them.
Among adults under 65, sixpercent who had private insurance still skipped medicines to save money.
10 percent of people who rely on Medicaid skipped their medicines.
Of those who are not insured, 14 percent skipped their medications because of cost.
Among the nation’s poorest adults— those with incomes well below the federal poverty level — nearly 14 percent “did not take medications as prescribed to save money.”
Those statistics get even worse when exploring prescription drug affordability in the Black community. According to the National Center for Biotechnology Information, a division of the National Institute of Health, “Elderly black Medicare beneficiaries are more than twice as likely as white beneficiaries to not have supplemental insurance and to not fill prescriptions because they cannot afford them.”
Likewise, an AARP survey of 1,218 African-American voters last year found more than three in five (62 percent) said “prices of prescription drugs are unreasonable” and nearly half (46 percent) said they did not fill a prescription provided by their doctor, mainly because of cost.
The inability to pay for prescription drugs – even for those under the age of 65 - has significantly impacted Blacks, Latinos and other people of color due to economic disparities.
“Though the Affordable Care Act (ACA) reduced the number of uninsured Americans, over 28 million remain without insurance,” says PublicHealthPost.org. “More than half (55%) of uninsured Americans under the age of 65 are people of color. For those with no insurance, paying retail prices for medications is often financially impossible.”
This is no secret to those who have been working in the trenches on critical health care issues daily for years.
Ruth Perot, executive director/CEO of the Summit Health Institute for Research and Education, Inc. (SHIRE), serves the 92 percent Black and largely low-income families of Washington, D.C.’s 6th, 7th and 8th Wards. She has been working on grassroots health equity isuses in communities of color for more than 23 years.
“I am certainly aware of the extent to which folks have to, of course make that choice between the cost of a prescription and the other commitments that they have, whether it’s rent or whether it’s food on the table or something related to the education for their children,” Perot said. “The cost of prescription drugs has always been out of control. It’s been a major profit-motive driven industry. That’s been true for some time. And so, whatever we see at the national level from a policy perspective still hasn’t addressed the fundamental issue that the drug prescriptions cost too much…I don’t think the federal government has ever used its power as the principle buyer of drugs to get those prices down. So, it’s been a persistent problem for many, many, many years if not decades.”
Edloe, having owned pharmacies in predominately Black communities, vehemently agrees. In addition to his medical career, he also interfaces with the community as pastor of the New Hope Fellowship Church in Hartfield, Va. As he personally works to avoid his family’s history with heart disease, he passes along health lessons to his congregation, and is intimately familiar with their struggles to pay for prescription drugs. Currently working with two groups involving health disparities and pharmaceuticals, he says he believes the answer to achieve equity will ultimately be “some form of universal health care.”
But, there must also be a culture change, he said. “Because a lot of health care providers still are not trained and the materials are still not designed for diverse communities. So it’s all about getting equity – not equality – but equity in health care. Because there’s a big difference. If everybody stands beside the fence and the fence is six feet and you’re 6 feet 5 inches tall, you can see over it, but other people can’t. Equity means you might have to give them a stool to see.”
This article is part of a series on the impact of high prescription drug costs on consumers made possible through the 2020 West Health and Families USA Media Fellowship.