Drug costs continue to be a concern for many patients as they leave our offices with prescriptions in hand, and for good reason. According to a recent survey by RxSaver by RetailMeNot, a digital medication savings tool, nearly half of all Americans say that their prescriptions cost more than their groceries every month. That means that many patients are going to forgo these therapies altogether. The same survey showed that early one in four (23%) Americans say a medical condition has become worse because they tried to avoid paying for medication they needed.
Prescription drug pricing is a deep and challenging discussion and has been the subject of many debates among the media and legislators over the past year. However, there are several quality of care issues tied to drug access and affordability that make this topic an important one for clinicians to consider as well.
The link between affordability and medication adherence
Studies suggest that at any one period in time, half of all patients are non-adherent. Cost and forgetfulness are among the top reasons for non-adherence. However, there are a variety of new technology-enabled adherence tools available today (even simple smartphone texting programs) that can help with forgetfulness, especially among older patients. But what about cost? Diving in a little deeper, we can see that is a far more complex issue, one that can’t be solved by new technology and resources alone.
For example, industry research shows that pharmacy benefits are changing—and not for the better. Patients increasingly face higher copays, more drug tiers and even prescription drug deductibles. This is adding to the burdens already faced by patients who have trouble affording high-cost medications, even when they have health insurance.
As physicians, while we have little control over these costs, there are strategies we can employ to help patients, especially as we counsel them about the importance of medication adherence. The following recommendations may be particularly useful for clinicians who serve uninsured or under-insured patients, including those on high-deductible health insurance plans.
“Comparison shopping” for the best drug prices
Many patients don’t realize that pharmacies can charge different prices for the same prescription drugs. As a result, you may to educate your patients on the importance of comparing drug prices across independent pharmacies and pharmacy chains—especially if you prescribe a very high-cost therapy. In addition, many large retailers have their own pharmacy savings programs, which may include discounted prices on today’s most frequently-prescribed medications. Fortunately, there are drug pricing look-up tools designed to make this process easier by eliminating the need to contact each pharmacy location. In addition, patients can easily compare the cost of brand name versus generic medications via these websites and apps. As an added benefit, these resources may also offer savings opportunities like coupons, which can lower drug costs even more.
While not all patients realize that these programs are available, awareness is growing, especially among younger consumers. According to RxSaver, nearly three in ten Americans have searched for coupons to save money on prescription drugs (29%) or compared prices across multiple pharmacies (26%). Generation Z/Millennials are 54% more likely than older generations (37% vs. 24%) to have searched for coupons to save money on their medication.
Looking for relief from government, manufacturer and nonprofit programs
There are also public programs, like the Medicare Extra Help program, which can help offset high out-of-pocket costs for lower-income seniors. (It is used in conjunction with, not to replace, Part D coverage.) This program can dramatically lower a Medicare member’s out-of-pocket drug costs, yet awareness of the program is generally low even among the neediest seniors.
For particularly expensive brand name drugs, manufacturer copay cards are often a go-to. However, you should carefully weigh the pros and cons of this approach, especially given that these cards generally expire within a year and tend to be promoted for therapies that already have a lower-cost therapeutic equivalent.
Out of all of the costly brand name medications available today, specialty drugs are among the most troubling when it comes to cost. Fortunately, many specialty pharmacies are skilled in connecting patients with financial assistance programs through nonprofits, charitable funds and drug manufacturers. You’ll want to be sure that your specialty pharmacy offers these services and helps patients through the enrollment process, which can be complex. In addition, you can encourage patients to download third-party apps that will even notify them when charitable foundation funds become available for specialty drugs, as these programs are often “first come, first served” and may have specific enrollment periods.
Keeping an eye on quality
As our industry looks to better quantify the impact of quality care, a focus on medication adherence—and by extension, drug affordability—has become more essential. For example, physicians involved in value-based reimbursement contracts are often incented to positively impact adherence rates. HEDIS scores from CMS include metrics tied to adherence with ACE inhibitors, oral diabetes
medications and statins, among others. Many private payer value-based reimbursement models replicate these same metrics.
But whether or not we are financially incented to do so, most physicians want to help patients better afford their treatment. We know it is a direct pathway to better adherence and clinical outcomes. One of the ways to do so is to include a conversation about drug affordability in patient counseling prior to the initiation of any new therapy. At an even broader level, we should look for ways to leverage our roles as clinical advisors and patient advocates by lending our voices to the national debate on prescription drug pricing.