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Illustration: Rebecca Zisser/Axios

A very small group of patients with major illnesses is responsible for an outsized share of health care spending, and new data show that prescription drugs are a big part of the reason their bills are so high.

The big picture: Among people who get their coverage from a large employer, just 1.3% of employees were responsible for almost 20% of overall health spending, averaging a whopping $88,000 per year.

Between the lines: “Persistently high spenders” are people who have accumulated big health care bills for at least 3 consecutive years.

  • They often have HIV, MS, cystic fibrosis, rheumatoid arthritis, diabetes, cancer and other serious conditions requiring frequent and often costly care.
  • Drugs are lifesavers for these patients, but also big offenders when it comes to costs.

By the numbers: Prescription drugs account for about 40% of this group’s costs, not counting rebates — compared with just 10% for the country as a whole. 

  • Their bills just for prescription drugs average out to about $34,000 per year. That’s much more than the average premium for family coverage.

Why it matters: These are exactly the people our insurance system is failing. They have insurance and a major illness, but still struggle with their medical bills as deductibles and other out-of-pocket costs keep rising faster than wages.

One solution might be to exempt this small group of high spenders with serious illnesses from drug or other copays, and limit their deductibles.

  • Congress is also considering proposals to lower the cost of the most expensive drugs, which could make a dent in both employer and employee spending for this population.

The bottom line: I have had family members in the 1.3%. 

  • I know from experience as well as the data that we should take care not to sacrifice needed care as we try to reduce spending for this small group of very high spenders with complicated medical needs.

Go deeper

Capitol repairs, security top $30M since Jan. 6 attacks

Photo: Bill Clark/CQ-Roll Call, Inc via Getty Images

The Architect of the Capitol Brett Blanton on Wednesday said that repairs and security expenses related to the Jan. 6 insurrection have already cost more than $30 million.

The state of play: Congressional appropriations committees have allocated the $30 million for repairs and perimeter fencing around the Capitol building through March 31, per NPR.

Updated 3 hours ago - Politics & Policy

White House stands by imperiled Tanden nomination after Senate panel postpones hearing

Neera Tanden. Photo: Anna Moneymaker/The New York Times/Bloomberg via Getty Images

The Senate Homeland Security Committee is postponing a confirmation hearing scheduled Wednesday for Neera Tanden, Axios has learned, a potential death knell for President Biden's nominee to lead the Office of Management and Budget.

The latest: Asked Wednesday afternoon whether Tanden has offered to withdraw her nomination, Psaki told reporters, "That’s not the stage we’re in." She noted that it's a "numbers game" and a "matter of getting one Republican" to support the nomination.

Acting Capitol Police chief: Officers were unsure of lethal force rules on Jan. 6

Photo: Chip Somodevilla/Getty Images

Acting U.S. Capitol Police Chief Yogananda Pittman wrote in prepared remarks for a House hearing on Thursday that officers in her department were "unsure of when to use lethal force" during the Jan. 6 insurrection.

Why it matters: Capitol Police did deploy lethal force on Jan. 6 — shooting and killing 35-year-old Ashli Babbit — but have faced questions over why officers appeared to be less forceful against pro-Trump rioters than participants in previous demonstrations, including those over Black Lives Matter and now-Supreme Court Justice Brett Kavanaugh.