One strategy is to monitor prescription cost assistance programs for the top five to 10 drugs the practice prescribes and routinely print information for patients in need.
It is an unfortunate reality: Rising prescription drug costs force many patients to skip doses or even forgo potentially life-saving medications. To reduce costs through competition, the Department of Health and Human Services’ (HHS) recently announced that drug manufacturers will soon be required to include list prices in television advertisements. According to HHS, 47% of Americans have high-deductible health plans (HDHPs), under which they often pay the list price of a drug until they have met their deductible. Patients also pay list prices if a drug is not on their insurance formulary.
The inability to afford prescription drugs continues to reach epidemic proportions.
- According to a recent Truven Health Analytics-NPR Health poll, 67% of patients do not take their medications because they cannot afford them.
- The same poll shows 94% of patients with incomes under $25,000 per year stated that they did not fill or pick up their prescriptions due to the expenses involved.
- More than 12% said that costs led them to stop taking a medication before a provider recommended ending the treatment.
- Recent data from the Centers for Disease Control and Prevention found that nearly 11% of individuals skipped medication doses or delayed filling a prescription simply to save money.
Why medication non-adherence undermines value-based payments
What is the connection between rising drug prices and value-based payments? When patients do not take their medications because they cannot afford them, they are automatically at risk for exacerbating chronic conditions. As a result, many are frequently admitted to the hospital or receive services in emergency departments when complications arise, driving up the overall cost of care. It is this cost of care that can make or break a physician’s performance under value-based payment models.
The link between medication non- adherence and higher healthcare costs is obvious. Medication adherence (or lack thereof) is often a predictor of 30-day hospital readmissions, according to a recent study published in Patient Preference and Adherence. The study found that patients with low or intermediate adherence had a 20% readmission rate as compared with approximately 9% for patients with high adherence.
Countless additional studies suggest that medication non-adherence drives up costs. For example, a recent study conducted by Express Scripts found that people who were non-adherent to their oral diabetes medications had 4% higher total healthcare costs compared to those who were adherent. Overall, nonadherence has been estimated to cost the U.S. healthcare system between $100 billion and $289 billion annually.
Seven tips to address financial barriers to medication adherence
To contain costs and improve outcomes under value-based payment models, medication adherence is paramount. This means physicians must address one of the biggest barriers: Cost of prescription drugs. Following are seven simple strategies to address financial barriers to medication adherence:
1. Help patients understand why they are taking certain medications. Discuss what medications are prescribed (and why) as well as the risk factors associated with non-adherence. This is especially true for medications used to treat conditions for which there are no noticeable symptoms. Asymptomatic patients may feel as though they do not need to take the drug and therefore decide to spend their money on basic necessities (e.g., food and clothing). However, one strategy to increase medication adherence is for life science reps to share patient educational materials that providers can give to patients during appointments. Physicians should give patients a couple of minutes to read the material and ask if they have any questions before concluding the visit.
2. Ask patients whether they can afford their medications. Patients do not typically volunteer this information because it may be embarrassing for them to admit their financial hardships. Instead, providers should ask patients directly. For example, consider stating the following: “I know that this medication can be expensive, and I want to be sure you are taking it as prescribed. Are you able to afford the medication, or is the cost a barrier? Please be honest so I can help you if needed.” Inquire whether patients plan to ration or share their medication for financial reasons, and create a ‘blame free’ environment to make patients feel comfortable about providing honest responses.
Once providers identify patients for whom cost is a barrier, they may be able to prescribe the maximum number of doses possible at one time (thus limiting the frequency of pharmacy visits). They may also be able to prescribe a medication that is on the patient’s insurance formulary or a medication for which a missed dose is less detrimental to long-term outcomes.
3. Do not over-rely on drug samples. Sample medications are truly meant for patients who are testing out a medication before taking it in the long term. When providers give these samples to patients who cannot afford their medications, they do not address the root cause of the problem. Once the samples run out, patients stop taking the drug until they are able to obtain more samples. This creates a dangerous gap that can lead to adverse outcomes.
4. Educate patients about prescription discount cards. There are a variety of free discount cards available online. Patients simply present one of these cards at a participating pharmacy and ask for pricing information using the discount card versus their insurance. Discount cards are particularly helpful for patients with HDHPs that may not have prescription drug coverage until they have met their deductible. They are also helpful for those without insurance.
5. Work with life science reps to stay up to date on what coupons and savings programs are available. Unfortunately, many providers do not know about these resources, or they simply do not have the time to track down current coupons for each patient. Only 16% of low-income individuals use a coupon to help reduce the price of their medications, according to the Truven Health Analytics-NPR Health poll. Practices that make time to meet with life science reps are able to stay abreast of all available savings opportunities to ensure patients take advantage of them.
6. Know what other Prescription Assistance Programs (PAP) are available for commonly prescribed medications. There are a variety of free online databases that allow users to type in the name of a drug and pull up all available PAPs, including basic program guidelines and application forms. It is helpful for a staff member to monitor these programs for the top five to 10 drugs the practice prescribes and routinely print information for patients in need. Practices can also help patients fill out application forms and obtain a physician signature before the patient leaves. The goal is to remove any and all barriers to these programs so patients get the help they need.
7. Encourage patients to shop around. Drug prices vary significantly by pharmacy, so encourage patients to comparison shop before filling their prescriptions. This is important for those without insurance coverage as well as those with HDHPs that choose to pay cash instead.
When it comes to medication adherence, physicians play an important role in terms of patient education and engagement. With the help of technology, this task is far less onerous than in the past, enabling physicians to help patients afford costly medications, improve outcomes and boost revenue under value-based payment models.