USA DRUG PRICES COMPARED TO THE WORLD Prescription drugs cost more in the US than in almost anywhere else in the world. As a result, Americans are illegally importing drugs from other countries.
In Canada and other developed countries, the same prescription drugs — manufactured in the same factories, by the same companies — are available for a fraction of the price compared to in the U.S. In fact, Americans spent $1,112 per person on prescription drugs in 2014, according to the Organization for Economic Co-operation and Development. Canadians, on the other hand, spent $772 over the same year. Online Canadian Pharmacy prices can range between 50 and 80 percent less than buying similar prescription drugs through your local U.S. pharmacies. CIPA certified online pharmacies follow the same prescription process as the U.S. mail-order companies, requiring a valid and signed prescription from the patient’s doctor or other licensed health care provider. Take Crestor, for example. AstraZeneca manufactures this drug that is used to prevent cardiovascular disease in those at high risk and treat abnormal lipids and sells it to consumers in the U.S., Canada, U.K., Australia, New Zealand, India, and Turkey.
One 40mg pill costs $259.58 in the U.S. compared to $69.30 in Canada. The price drops even more to $2.21 in the U.K., Australia and New Zealand. In India and Turkey, the same pill costs less than 37 cents. Cymbalta is also sold at a significantly higher price in the U.S. than elsewhere in the world. Shionogi and Eli Lilly co-develop and co-market duloxetine HCl in Japan. Duloxetine, marketed in many countries as Cymbalta the antipsychotic drug in Japan and sells it in the U.S. for $34.51 per pill. The same pill costs $4.65 in Canada — 87 percent less than in the U.S. Many of the most expensive drugs are taken for an extended period of time, and costs quickly add up. The following are the 9 most expensive drugs, period, in the U.S., taking into account both drugs you can get at a pharmacy and healthcare practitioneradministered drugs. Relatively few people take most of these drugs — but their outsized costs can translate into higher premiums and more restrictive formularies for everyone.
Crestor - $3175.5 Crestor (rosuvastatin) is a drug that is used in conjunction with a healthy diet to decrease “bad” cholesterol levels, raise “good” cholesterol levels, and lower triglycerides (a type of fat in the blood). It is prescribed for adults and children aged 8 and up. This drug is also used: a) In adults, to prevent plaque accumulation in blood arteries, which can obstruct blood flow. b) In males 50 years and older and women 60 years and older who have coronary heart disease or other risk factors, reduce the risk of stroke, heart attack, and certain other heart problems. c) To treat forms of high cholesterol that are hereditary.
Crestor Side Effects in Women and Men Common: Headache Weakness Muscle aches Nausea, stomach pain If you develop any of the following symptoms, contact your doctor right away: Unexplained muscle pain or weakness Hip, shoulder, neck, and back muscle weakness Trouble lifting your arms Trouble climbing or standing Memory problems or confusion Liver problems This drug might cause serious adverse effects. If you have any significant side effects, contact your doctor immediately, or dial 911 or your local emergency number.
Crestor Side Effects in Women and Men These aren’t the only adverse effects that come with it. Other, perhaps more rare side effects should be discussed with your doctor and pharmacist. Before using this medication, inform your doctor of any of the following: Allergies you have Medications you are taking Previous medical history Pregnant or breastfeeding Alcohol consumption
Crestor comes in tablet form. You can take this with or without food, and the manufacturer suggests taking it once a day. And it is supplied as 5 mg, 10mg, 20mg and 40mg. Crestor is used once a day in doses ranging from 5 to 40 mg in adults. 10 to 20 mg once daily is the typical beginning dosage. Make sure you follow your doctor’s dose and use instructions. Your treatment plan will be personalized to your requirements and the problem you’re dealing with. The medical condition being treated, pediatric doses, cholesterol levels, and other factors all impact dosages. Talk to your doctors about dosages and any related questions.
Crestor Price Country
Strength and Quantity
Price in $US
US
40 mg, 1 pill
8.70
Canada
40 mg, 1 pill
0.40
UK
40 mg, 1 pill
0.81
Australia
40 mg, 1 pill
0.37
India
40 mg, 1 pill
0.63
Cymbalta - $3285 Cymbalta is a prescription drug that is used to treat a variety of ailments. This medication is used to treat the following conditions in adults: a. b. c. d.
Major depressive disorder (MDD) Generalized anxiety disorder (GAD) Diabetic neuropathy causing pain (nerve damage) Fibromyalgia
Chronic musculoskeletal pain This is also used to treat the following conditions in children: i. GAD in children aged 7 and up ii. Fibromyalgia in children aged 13 and up
Cymbalta Side Effects Mild: Decreased appetite Dizziness Dry mouth Excess sweating Lack of energy Sleepiness Headache trouble sleeping Digestive problems Sexual side effects The majority of these adverse effects should subside within a few days or weeks. However, if the symptoms worsen or do not go away, see your doctor.
Cymbalta Side Effects Serious: Liver damage Orthostatic hypotension Serotonin syndrome Severe skin reactions Eye problems Low sodium levels Trouble urinating
Cymbalta Side Effects Serious: High blood pressure Unusual bruising and/or bleeding Withdrawal symptoms Allergic reaction Suicidal thoughts and behaviors This drug might cause serious adverse effects. If you have any significant side effects, contact your doctor immediately, or dial 911 or your local emergency number. These aren’t the only adverse effects that come with it. Other, perhaps more rare side effects should be discussed with your doctor and pharmacist. Before taking this medicine, tell your doctor about any allergies you have, medications you are taking, pregnant or breastfeeding, and any previous medical history you have.
Cymbalta Dosage This medication is provided in the form of an oral capsule. There are three strengths of capsules available: 20 mg, 30 mg, and 60 mg. Your doctor’s Cymbalta dosage will be determined by a number of factors. These are some of them: The kind and severity of the disease you’re treating with this medication Age You may struggle with other medical problems Medications you are currently taking How this medication affects your disease Side effects experienced Usually, your doctor begins at a low dose then they’ll tweak it overtime to find the optimum quantity for you. In the end, your doctor will prescribe the smallest dose that produces the desired effect. Make certain to take the dose given to you by your doctor.
Cymbalta Price Country
Strength and Quantity
Price in $US
US
40 mg, 1 pill
9
Canada
40 mg, 1 pill
0.45
UK
40 mg, 1 pill
0.88
Australia
40 mg, 1 pill
0.62
India
40 mg, 1 pill
0.23
Daliresp - $4712.5 This medication is used to treat and prevent the symptoms of chronic obstructive pulmonary disease (COPD), such as wheezing and shortness of breath. To treat COPD, it should be used with other medicines (bronchodilators like salmeterol and ipratropium). Controlling the symptoms of breathing problems may allow you to return to work or school sooner.
Daliresp side effects Common Nausea Diarrhea Loss of appetite Weight loss Headache Dizziness Sleep problems Back pain Cold and flu symptoms
Daliresp side effects Serious Mood and behavioral changes Anxiety Depression Trouble sleeping Impulsive thinking Thoughts of suicide Fast and unintentional weight loss Pain or burning with urination Tremors This drug might cause serious adverse effects. If you have any significant side effects, contact your doctor immediately, or dial 911 or your local emergency number.
Daliresp side effects These aren’t the only adverse effects that come with it. Other, perhaps more rare side effects should be discussed with your doctor and pharmacist. Before taking this medicine, tell your doctor about any allergies you have, medications you are taking, and any previous medical history you have. Inform your doctor about all of your existing medications, as well as any that you begin or stop taking. Many medicines interact with one another, and certain pharmaceuticals should never be used together.
Daliresp 500 mcg The initial dose of Daliresp 250 mcg is just for the first four weeks of therapy and is not the effective (therapeutic) amount. Daliresp is taken once a day, with or without meals, at a dosage of 500 micrograms (mcg), as the maintenance dose. In certain individuals, starting therapy with Daliresp 250 mcg once daily for four weeks and then increasing to Daliresp 500 mcg once daily may lower the risk of treatment cessation. The effective (therapeutic) dosage is not however 250 mcg per day. Always follow your doctor’s guidelines about the dosage and usage of this medication.
Daliresp/Rofaday/Fluticasone/Salmeterol Prices Country
Strength and Quantity
Price in $US
US
500 mcg, 1 pill
12.9
Canada
500 mcg, 1 pill
3.08
UK
500 mcg, 1 pill
3.50
Turkey
500 mcg, 1 pill
1.66
India
500 mcg, 1 pill
0.20
Dexilant - $2491 This medication is a prescription brand name drug that may be used in a variety of ways, including: To aid in the healing of erosive esophagitis To alleviate heartburn and control symptoms of erosive esophagitis that has already healed Help alleviate the symptoms of gastric reflux (GERD) This medication includes the medication Dexlansoprazole, which belongs to the proton pump inhibitor (PPI) family of medicines. PPIs operate by preventing acid from being pumped into the stomach by specific stomach cells. This medication is safe to use in adults as well as children aged 12 and above.
Dexilant Dosage Your doctor’s Dexilant dose will be determined by a number of factors. These are some of them: Age The illness you’re treating with this medication. Liver function Regardless of widely used or suggested doses, follow your doctor’s instructions and take the dosage that they recommend. Your physician will prescribe the appropriate dose for you.
Dexilant Side Effects Common in adults: Diarrhea Abdominal pain Nausea Upper respiratory infections Vomiting Flatulence Common in children: Headache Abdominal pain Diarrhea The common cold Mouth and throat pain
Dexilant Side Effects
Serious in adults and children: Inflamed kidney Diarrhea associated with C.diff Bone fracture Lupus Vitamin B-12 deficiency Low magnesium levels Abnormal growth in the stomach Serious allergic reaction
Dexilant Side Effects This medication might cause serious adverse effects. If you have any significant side effects, contact your doctor immediately once. If your symptoms are lifethreatening or you believe you’re suffering a medical emergency, dial 911 or your local emergency number. These aren’t the only adverse effects that come with it. Other, perhaps more rare side effects should be discussed with your doctor and pharmacist. Before taking this medicine, tell your doctor about any allergies you have, medications you are taking, and any previous medical history you have.
Dexilant/Deltone/ Cost Country
Strength and Quantity
Price in $US
US
30 mg, 1 pill
6.83
Canada
30 mg, 1 pill
3.06
UK
30 mg, 1 pill
1.07
Australia
30 mg, 1 pill
1.19
India
30 mg, 1 pill
0.21
Incruse Ellipta $1022 Adults with chronic obstructive pulmonary disease (COPD) are treated with Incruse Ellipta, a brand-name prescription medication. COPD is a lung disease that makes it difficult to breathe. Chronic bronchitis and emphysema are among the illnesses that cause it. The Incruse Ellipta is intended to be used as a long-term COPD therapy. When taken on a regular basis, it helps to lessen the symptoms of the illness over time. Incruse Ellipta, on the other hand, is not a rescue inhaler. It also shouldn’t be used to treat acute respiratory difficulties.
Incruse Ellipta: How to Use Your doctor or pharmacist can explain you how to take Incruse Ellipta properly before you take it for the first time. On the manufacturer’s website, you can also watch an instructional video. Checklist of steps: 1. Examine the dosage counter. (At no point should you shake.) 2. Keep sliding the cover down until you hear a click. 3. Breathe slowly out (away from inhaler) 4. Close your lips and place the mouthpiece in your mouth to establish a proper seal. (Do not use your fingers to obstruct the air vent.) 5. Inhale deeply and steadily. 6. Hold your breath for 5 seconds or as long as you feel comfortable doing so. 7. Remove the inhaler from your mouth while holding your breath. 8. Breathe slowly out.
Incruse Ellipta Dosing Incruse Ellipta is a powder that is inhaled once a day via an inhaler. It comes in only one strength: 62.5 mcg.
Incruse Ellipta Side Effects
Common: Joint pain Cough Upper respiratory infections Stuffy or runny nose Throat pain Change in taste Muscle pain Tooth ache Belly pain Increase in heart rate Irregular heartbeat Skin bruising
Incruse Ellipta Side Effects Serious: Unexpected bronchospasm Eye problems Urinary retention Severe allergic reaction This drug might cause serious adverse effects. If you have any significant side effects, contact your doctor immediately, or dial 911 or your local emergency number. These aren’t the only adverse effects that come with it. Other, perhaps more rare side effects should be discussed with your doctor and pharmacist. Before taking this medicine, tell your doctor about any allergies you have, medications you are taking, and any previous medical history you have.
Incruse Ellipta Cost Country
Strength and Quantity
Price in $US
US
62.5mcg
351.22
Canada
62.5mcg
90.90
UK
62.5mcg
52.45
Australia
62.5mcg
227.92
India
62.5mcg
167.50
Dulera Inhaler - $127 Formoterol and mometasone are combined in Dulera inhaler. Formoterol is a long-acting bronchodilator that improves breathing by relaxing the muscles in the airways. Mometasone is a corticosteroid that inhibits the release of inflammatory chemicals in the body. Dulera is a medication that is used to treat and prevent asthma symptoms in adults and children aged 5 and up.
Dulera Inhaler Dosage Maintenance Dose for Asthma in Adults: Orally inhale two inhalations twice a day (morning and evening). Mometasone (100 mcg or 200 mcg) and formoterol (5 mcg) are used in each inhalation Maximum daily dosage: 800 mcg mometasone and 20 mcg formoterol. Maintenance Dose for Asthma in Children: For children 12 and up: orally inhale two inhalations twice a day (morning and evening). Mometasone (100 mcg or 200 mcg) and formoterol (5 mcg) are used in each inhalation Maximum daily dosage: 800 mcg mometasone and 20 mcg formoterol Stated above are just the usual doses give. Therefore, be sure to stick to the dosage and usage guidelines given to you by your doctor.
Side Effects of Dulera Inhaler Common: Stuffy nose Hoarse or deep voice Dry mouth Sore throat headache Sinus pain Changes in menstrual periods Dizziness Anxiety Headache Sleeping problems Back pain Muscle cramps Cough Skin rash Itching
Side Effects of Dulera Inhaler Serious: Serious allergic reaction Oral thrush, and similar mouth or throat infections Paradoxical bronchospasm Glaucoma High blood sugar Low potassium Low cortisol Decreased bone density Withdrawal symptoms
Side Effects of Dulera Inhaler Dulera Inhaler might cause serious adverse effects. If you have any significant side effects, contact your doctor immediately, or dial 911 or your local emergency number. These aren’t the only adverse effects that come with it. Other, perhaps more rare side effects should be discussed with your doctor and pharmacist. Before taking this medicine, tell your doctor about any allergies you have, pregnant or breastfeeding, medications you are taking, and any previous medical history you have.
Dulera Inhaler/ Formost 200 Inhaler (Formoterol & Mometasone) Price Country
Strength and Quantity
Price in $US
US
5mcg
2.80
Canada
5mcg
2.10
UK
5mcg
0.31
Australia
5mcg
0.54
India
5mcg
0.40
Emend - $432 Emend (Aprepitant) is an oral medicine that is used to alleviate nausea and vomiting caused by surgery or chemotherapy. Emend is intended to prevent these symptoms from occurring; it does not treat nausea or vomiting that has already begun. It’s generally used in conjunction with other medications.
Emend Dose Each capsule for oral administration comprises of either Emend 40 mg, 80 mg, or 125 mg. Each oral suspension pouch comprises 125 mg (for individuals who are unable to take oral capsules) Dosage: The doses listed above are only a sample of the most common. Remember that your doctor’s dosage and usage recommendations will be customized to your medical needs and conditions. If you have any questions about the dose or how to use it, talk to your doctor.
Emend Dose The typical dosage for chemotherapy-induced nausea and vomiting in adults is: Strong chemotherapy: 1. Day 1: 125 mg orally 1 hour before chemotherapy 2. Day 2 and 3: 80 mg orally, in morning 3. Duration of therapy: 3 days Moderate chemotherapy: 4. Day 1: 125 mg orally 1 hour before chemotherapy 5. Day 2 and 3: 80 mg orally, in morning 6. Duration of therapy: 3 days The typical adult dose for postoperative nausea and vomiting is: Single, oral 40 mg dose administered 3 hours prior to anesthesia
Emend Side Effects Common: Tiredness Hiccups Nausea Vomiting Heartburn Abdominal pain Diarrhea Constipation Loss of appetite Hair loss Headache Dizziness Mild skin rash Ringing in the ears Sleeping problems
Emend Side Effects Serious: Feeling like you will/might pass out Low blood cell counts: Fever Chills Tiredness Mouth sores skin sores Easy bruising Unusual bleeding Pale skin
Emend Side Effects Serious: Cold hands and feet Short of breath Dehydration symptoms Feeling like you will/might pass out Feeling thirsty or hot Being unable to urinate Heavy sweating Hot and dry skin There’s a risk this medication will have significant side effects. If you have any serious side effects, call your doctor or phone 911 or your local emergency number right away.
Emend Side Effects These aren’t the only drawbacks of employing it. Other, maybe more uncommon, adverse effects should be discussed with your doctor and pharmacist. Notify your doctor before using this medicine if you have: Any allergies Are taking any medications, including over the counter medications and supplements Have or had any previous health issues Pregnancy status Breastfeeding status
Emend Price Country
Strength and Quantity
Price in $US
US
125mg
339.33
Canada
125mg
79.11
UK
125mg
5.25
Australia
125mg
78.0
India
125mg
6.09
Entresto - $1917 Emend (Aprepitant) is an oral medicine that is used to alleviate nausea and vomiting caused by surgery or chemotherapy. Emend is intended to prevent these symptoms from occurring; it does not treat nausea or vomiting that has already begun. It’s generally used in conjunction with other medications.
Entresto Dose Entresto comes in three strengths: 1. 24/26 mg: 24 mg of sacubitril with 26 mg of valsartan 2. 49/51 mg: 49 mg of sacubitril with 51 mg of valsartan 3. 97/103 mg: 97 mg of sacubitril with 103 mg of valsartan The pills in Entresto are designed to be swallowed. If you can’t take the tablets, your pharmacist can smash them and combine them with a liquid to drink. An oral suspension is the name for this type of medication.
Entresto Dose Your doctor’s Entresto dose for you will be determined by a number of factors. These are some of them: The severity and types of your condition Age and weight Form of Entresto you are given Past and current medical conditions Your doctor will usually start you on a modest dose. Then they’ll tweak it over time to find the optimum quantity for you. In the end, your doctor will prescribe the smallest dose that produces the desired effect. Make careful to follow your doctor’s instructions about dosage. The dosage you should take will be determined by your doctor.
Entresto Side Effects Common: Cough Dizziness Abdominal pain Irregular heartbeat Nausea and vomiting Numbness
Entresto Side Effects Serious : Kidney problems High potassium levels Severe allergic reaction Hypotension Fetal toxicity This drug might cause serious adverse effects. If you have any significant side effects, contact your doctor immediately, or dial 911 or your local emergency number. These aren’t the only adverse effects that come with it. Other, perhaps more rare side effects should be discussed with your doctor and pharmacist. Before taking this medicine, tell your doctor about any allergies you have, medications you are taking, and any previous medical history you have.
Entresto cost / Entresto price Country
Strength and Quantity
Price in $US
US
51mg, 1 pill
10.76
Canada
51mg, 1 pill
3.10
UK
51mg, 1 pill
1.85
Australia
51mg, 1 pill
8.50
India
51mg, 1 pill
0.50
Flovent HFA - $415 Flovent HFA is a medication used to treat asthma in people aged 4 and above. It also aids in the prevention of asthma symptoms when used on a regular basis. Fluticasone propionate, a synthetic corticosteroid, is the active ingredient in Flovent HFA. Corticosteroids are naturally occurring chemicals in the body that aid in the battle against inflammation. Asthma is treated with corticosteroids, which decrease inflammation in the airways. Flovent HFA does not help with asthmatic breathing difficulties that occur suddenly. Always keep a backup rescue inhaler on hand to address unexpected symptoms. If you don’t have a rescue inhaler, make an appointment with your doctor to get one.
Flovent HFA Usage Flovent HFA is a fluticasone inhaler that comes in an aerosol form. This gadget produces a spray that you inhale into your lungs through your mouth. How to use an inhaler can be shown to you by your doctor or pharmacist. Read any drug guides or instruction sheets and follow all recommendations on your prescription label. Follow the medication’s instructions to the letter. Do not take the medication more than you are prescribed. After using this drug, rinse your mouth with water (do not swallow) to avoid a yeast infection. Keep a watchful eye on your dental hygiene. Fluticasone can cause tooth decay and discoloration.
Flovent HFA Side Effects Common: Cold symptoms including stuffy nose, sneeze, sore throat, sinus pains Low fever Cough Wheezing Tightness in chest Hoarse voice White patches/sores in mouth Headache Nausea Vomiting Stomach upset
Flovent HFA Side Effects Serious: Weakness Tiredness Nausea Vomiting Light headedness Wheezing Choking Breathing problems after use Eye problems Worsening of your asthma symptoms Fever Cough Stomach Pain Weight Loss
Flovent HFA Side Effects Serious: Skin rash Numbness or tingling Chest pain Stomach pain Loss of appetite Dark urine Clay colored stools Yellowing of skin and eyes
Flovent HFA Side Effects This drug might cause serious adverse effects. If you have any significant side effects, contact your doctor immediately, or dial 911 or your local emergency number. These aren’t the only adverse effects that come with it. Other, perhaps more rare side effects should be discussed with your doctor and pharmacist. Before taking this medicine, tell your doctor about any allergies you have, medications you are taking, and any previous medical history you have.
Flovent HFA Price Country
Strength and Quantity
Price in $US
US
250mcg, 1
781
Canada
250mcg, 1
152
UK
250mcg, 1
152
New Zealand
250mcg, 1
152
Australia
250mcg, 1
152
Should Americans Be Allowed to Buy Medication from Other Countries? Data show 36 million American adults did not fill a prescription in 2016 because of the cost. This figure does not include millions of patients over the age of 65 and under the age of 18. According to Gabriel Levitt, President of Pharmacy Checker, “This burden of high drug prices is placed on middle-class Americans and it can bankrupt them and it often does bankrupt them — especially for cancer patients,” Levitt said. “To put the burden on them is unjust and unethical.” Over the past year, several cities, counties, and school districts have started helping employees buy medicines from Canada and overseas to save money, according to Kaiser Health News report. Levitt said more people could benefit from importing drugs into the U.S. now, but technically it’s against the law. “There are real regulatory obstacles,” Levitt said. “Drug companies pay a lot of money on scare tactics to discourage Americans from buying from online pharmacies.”
Did you know? 36 million American adults did not fill a prescription in 2016 because of the cost.
Citations U.S. Drug Prices vs The World https://www.drugwatch.com/featured/us-drug-prices-higher-vs-world/ Bluth, R. (2016, December 17). Looking for Bargains, Many Americans Buy Medicines Abroad. Retrieved from https://www.npr.org/sections/health-shots/2016/12/17/505690791/looking-for-barga ins-many-americans-buy-medicines-abroad Cohen, R. & Villarroel, M. (2015, January). Strategies Used by Adults to Reduce Their Prescription Drug Costs: United States, 2013. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db184.htm Galewitz, P. (2017, December 5). Cities, counties and schools sidestep FDA foreign drug crackdown, saving millions. Retrieved from https://www.washingtonpost.com/national/health-science/cities-counties-and-schoo ls-sidestep-fda-foreign-drug-crackdown-saving-millions/2017/12/05/eb21d458-d9f d-11e7-b859-fb0995360725_story.html?utm_term=.7dbd3484c268
Citations IHS Markit. (n.d.). US drug prices versus other developed countries: Risk of aligning prices across markets. [Press Release] National Academies of Sciences, Engineering, and Medicine. (2017) Making Medicines Affordable: A National Imperative. Retrieved from https://www.nap.edu/catalog/24946/making-medicines-affordable-a-national-impera tive OECD. (n.d.). Pharmaceutical Spending Total, US dollars/capita, 2014. Retrieved from https://data.oecd.org/chart/4NYS PharmacyChecker.com. (2017, August 3). 70% of Popular Brand Name Drugs Sold in U.S. Pharmacies Are Imported; Cost Up to 87% Less in Canada. [Press Release] Retrieved from https://www.pharmacychecker.com/news/70-percent-of-brand-name-drugs-are-impo rted-cost-87-percent-less-in-canada/
Citations Sanders.Senate.gov. (2017, February 28). Affordable and Safe Prescription Drug Importation Act Introduced to Help Lower Skyrocketing Cost of Medicine. [Press Release] Retrieved from https://www.booker.senate.gov/news/press/affordable-and-safe-prescription-drug-im portation-act-introduced-to-help-lower-skyrocketing-cost-of-medicine S. S. 2157, Drug-Price Transparency in Communications Act Cong. (2017). Retrieved from https://www.congress.gov/bill/115th-congress/senate-bill/2157?r=4 The Henry J. Kaiser Family Foundation. (2016, November). Kaiser Health Tracking Poll. Retrieved from https://files.kff.org/attachment/Kaiser-Health-Tracking-Poll-November-2016-Toplin e