The Implications of Rising Healthcare Costs Among At-Risk Populations


Did you know that nearly 3 in 10 Americans admit to cutting their pills in half, skipping doses, or even discontinuing their medications when drug costs rise? This alarming reality sheds light on the growing problem of skyrocketing prescription prices in the United States.

This predicament leaves individuals battling chronic conditions, such as chronic kidney disease (CKD), at the crossroads of health and finance. However, recent research findings shed light on potential solutions and legislative efforts aimed at addressing escalating healthcare costs.

Understanding CKD

CKD progression follows various trajectories, some slow and others rapid. A study on Medicare Advantage enrollees highlighted that a portion of those with accelerated CKD progression incur significantly higher healthcare costs.

A small percentage of CKD patients often require expensive treatments like dialysis or transplantation, so early detection is vital for CKD management. It allows timely interventions like lifestyle changes and medication management, which can slow CKD progression, reduce the need for expensive treatments, and improve patient outcomes.

The Cost of CKD

The cost of CKD varies by stage. In 2016, CKD costs exceeded $79 billion, with expenses rising as CKD progresses. Costs in 2010 ranged from $1,700 for stage 2 CKD to $12,700 for stage 4 CKD.

Individuals with CKD and End-Stage Renal Disease (ESRD), face more burdensome medication expenses. In 2018, Medicare beneficiaries faced significant out-of-pocket costs for Medicare Part D covered drugs: $400 for all ESRD patients, $381 for hemodialysis recipients, and $569 for peritoneal dialysis patients.

In response to escalating drug costs, the Inflation Reduction Act has emerged as a potential solution. This legislation aims to curb excessive prescription drug price increases above inflation rates. Lowering drug costs can potentially save Medicare recipients between $1 and $372 per average dose.

How CKD Affects Self-Funded Plans

CKD poses a significant financial challenge for self-funded employers in the United States. Employer-sponsored health plans pay 4 to 5 times more for dialysis than Medicare, causing self-funded health plans to spend around $300,000 annually for three years before Medicare takes over.  Our recent webinar explores self-funded employers’ rights to carve out dialysis benefits and reveals strategies to control these predatory costs.


Rising drug prices in the United States lead many, including those with CKD, into risky health choices. Detecting CKD early is vital for cost reduction. Self-funded employers face CKD’s financial challenges, which emphasizes the need for cost-effective strategies. Legislative actions promote drug price transparency, and through the Inflation Reduction Act, seek to restrain excessive hikes, potentially improving affordability for Medicare beneficiaries.


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