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Nearly one-third of Americans said they skipped taking a prescribed medicine because it was too expensive, according to a poll this summer from the Kaiser Family Foundation.

Americans have consistently said in survey after survey that healthcare is a top concern, and they are specifically worried about the cost of prescription drugs.

This year has been particularly challenging for Arizonans to cover the cost of prescription drugs. In the first half of 2019, pharmaceutical companies increased the cost of more than 3,400 drugs, an increase of 17% from the same time period in 2018. The average price increase was over 10%, according to an analysis from Rx Savings Solutions, a consulting firm advising employers on health care costs.

In June, the Arizona Republic reported that people in the state were struggling to find a cheaper insulin that Eli Lilly brought to the market earlier this year, after the cost of insulin skyrocketed.

Julie and Taylor Hoffman, Phoenix residents, were “instantly relieved” when they heard a cheaper product was available, but after calling more than 100 individual Arizona pharmacies it was nowhere to be found.

“Every single pharmacy in Arizona has told me no. It’s nowhere to be found,” Julie Hoffman told the Republic. “It’s indicative of what we’ve been dealing with for years and relevant just to the state of the pharmaceutical industry.”

Another threat looms when it comes to the cost of prescription drugs. Arizona is one of the 19 states suing the federal government, arguing that the Affordable Care Act (ACA) is unconstitutional. A decision from a federal appeals court is expected in the next few weeks.

If the judges rule the ACA is unconstitutional, AARP estimates that over 94,000 seniors in Arizona could end up paying more for prescription drug costs. That’s because the ACA reduces costs for seniors in what has long been known as the “donut hole,” when seniors pay 100% of drug costs instead of having some expenses picked up by Medicare.