Data Brief | | August 2024

District of Columbia Survey Respondents Worry about High Drug Costs; Support a Range of Government Solutions

According to a survey of more than 1,000 District of Columbia adults, conducted from March 14 to May
15, 2024, respondents across the state are concerned about prescription drug costs and express a strong
desire for policymakers to enact solutions.

Nearly half (47%) of survey respondents reported being somewhat or very worried about affording the
cost of prescription drugs. Worry varied substantially by income group, with respondents in households
making between $75,000 and $100,000 per year experiencing the most worry (see Figure 1).¹ However, it
is important to note that a percentage of households making above $100,000 per year also reported
worrying about the cost of prescription drugs.

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In addition to the concerns about affording prescription drugs in the future, the survey reveals that more
than a quarter of respondents (29%) have had to ration medication due to cost concerns in the last year,
which for the purpose of this brief is defined as not filling a prescription, cutting pills in half or skipping a
dose (see Figure 2).

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Lower-income respondents and respondents enrolled in DC Healthy Families, the state Medicaid program, reported the highest rates of rationing medications due to cost. However, these hardships are also prevalent in middle-income households. Also of note, respondents living in households with a person with a disability reported higher rates of rationing medication due to cost when compared to respondents
without a disabled household member (see Table 1).

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Respondents enrolled in DC Healthy Families, the state Medicaid program, reported some of the highest
rates of rationing medication due to cost. When asked to elaborate on the conditions which led them to
ration or forgo care, respondents provided a variety of examples including the medication not being
covered and challenges meeting prior authorization requirements (see Table 2).

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Considering the challenges respondents reported concerning prescription drug affordability, as well as
concerns about high health care costs generally,2 it is not surprising that District of Columbia respondents
are generally dissatisfied with the health care system. In fact, just 40% of respondents agreed or strongly
agreed that the United States health care system is "great," while 73% agreed or strongly agreed that the
United States health care system needs to change.
District of Columbia respondents also frequently reported that they believe that pricing decisions made
by drug companies are a major reason for high health care costs. In fact, out of fifteen options, the most
frequently cited reasons for high health care costs were:

• 63% — Drug companies charging too much money
• 61% — Hospitals charging too much money
• 61% — Insurance companies charging too much money

When it comes to tackling high drug costs, District of Columbia respondents endorsed a number of
prescription drug-related strategies, including:

• 90%— Cap out-of-pocket costs for life-saving medications, such as insulin;
• 88%— Authorize the Attorney General to take legal action to prevent price gouging;
• 88%— Set standard prices for drugs to make them affordable;
• 85%— Prohibit drug companies from charging more in the U.S. than abroad; and
• 85%— Establish a Prescription Drug Affordability Board to examine evidence and establish acceptable costs for prescription drugs.

Moreover, there is strong bipartisan support for a variety of policies designed to address unaffordable
prescription drug costs. For example, nearly all (88% of) respondents agreed that drug companies should
be required to provide advance notice of price increases and to provide information to justify those
increases, including 82% of respondents identifying as a Republican, 93% of respondents identifying as a
Democrat and 82% of unaffiliated respondents (see Table 3).

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While District of Columbia respondents support government action to address high drug costs, they also
see a role for themselves. Fifty-three percent (53%) would switch from a brand-name to an equivalent
generic drug if given the chance, and 60% have sought or attempted to find the cost of a prescription
drug beforehand.

Conclusion

The high burden of health care and prescription drug affordability, along with high levels of support for
change, suggests that elected leaders and other stakeholders need to make addressing this consumer
burden a top priority. Recent legislative action at both the federal and state levels may positively impact
consumer affordability, specifically for prescription drugs used to treat chronic conditions such as insulin,
epinephrine autoinjectors and asthma inhalers. Annual surveys can help assess whether progress is being made.

Notes

1. Median household income in District of Columbia was $101,722 (2018-2022). U.S. Census, Quick Facts. Retrieved from: U.S. Census Bureau QuickFacts: District of Columbia
2. For more detailed information about health care affordability burdens facing District of Columbia respondents, please see Healthcare Value Hub, District of Columbia Residents Struggle to Afford High Healthcare Costs; Worry About Affording Health Care in the Future; Support Government Action across Party Lines, Data Brief (August 2024).

Methodology

Altarum's Consumer Healthcare Experience State Survey (CHESS) is designed to elicit respondents' views on a wide range of health system issues, including confidence using the health system, financial burden and possible policy solutions. This survey, conducted from March 14 to May15, 2024, used a web panel from Dynata with a demographically balanced sample of approximately 1,180 respondents who live in District of Columbia. Information about Dynata's recruitment and compensation methods can be found here. The survey was conducted in English or Spanish and restricted to adults ages 18 and older.
Respondents who finished the survey in less than half the median time were excluded from the final sample, leaving 1,079 cases for analysis. After those exclusions, the demographic composition of respondents was as follows, although not all demographic information has complete response rates: