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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

Air quality alerts issued as California fires threaten more sequoias

The Windy Fire blazes through the Long Meadow Grove of giant sequoia trees near the Trail of 100 Giants in Sequoia National Forest, near California Hot Springs, on Tuesday. Photo: David McNew/Getty Images

Two wildfires were threatening California's sequoia trees over overnight, hours after authorities issued fresh evacuation orders and warnings, along with air quality alerts on Wednesday.

The big picture: Officials in the Bay Area and the San Joaquin Valley issued air quality alerts as smoke from the Windy and KNP Complex fires resulted in hazy, "ash-filled" skies from Fresno to Tulare, the Los Angeles Times notes.

Asymptomatic Florida students exposed to COVID no longer have to quarantine

Florida Gov. Ron DeSantis during a September news conference in Viera, Fla. Photo: Paul Hennessy/SOPA Images/LightRocket via Getty Images

Florida Gov. Ron DeSantis (R) announced Wednesday an emergency order allowing parents to decide whether their children should quarantine or stay in school if they're exposed to COVID-19, provided they're asymptomatic.

Why it matters: People infected with COVID-19 can spread the coronavirus starting from two days before they display symptoms, according to the CDC. Quarantine helps prevent the virus' spread.

Federal judge: Florida ban on sanctuary cities racially motivated

Florida Gov. Ron DeSantis. Photo: Joe Raedle/Getty Images

A federal judge on Tuesday struck down parts of a Florida law aimed at banning local governments from establishing sanctuary city policies, arguing in part that the law is racially motivated and that it has the support of hate groups.

Why it matters: In a 110-page ruling issued Tuesday, U.S. District Judge Beth Bloom said the law — signed and championed by Gov. Ron DeSantis (R) — violates the Constitution's Equal Protection Clause because it was adopted with discriminatory motives.