A large health system and a multispecialty clinic have gotten a handle on drug costs through close collaborations with outside entities.
- The lack of affordability of many prescription drugs is affecting the patient experience and healthcare outcomes.
- Regardless of whether policy solutions emerge from Congress or the White House, providers are taking the initiative to tackle the problem.
- One of the nation’s largest health systems worked with a vendor to establish a specialty pharmacy, improving access to vital drugs and reducing costs.
- A multispecialty clinic and regional health plan collaborated on a mechanism that nudges physicians to prescribe less-expensive drugs.
After receiving a diagnosis of hepatitis C, Yvonne Nicholson learned about her treatment options. A drug called Harvoni, which has emerged as a leading choice of prescribing physicians since the FDA approved it in October 2014, could cure the disease if taken for a 12-week period.
The obvious concern was the price tag: $1,000 per pill and $81,000 for the full regimen.
Given that Medicare covered only part of the cost, Nicholson could not have afforded the medication without help from the specialty pharmacy program at St. Joseph’s Hospital & Medical Center in Phoenix. Staff at the specialty pharmacy arranged for a charitable grant to cover the balance, ensuring Nicholson would pay nothing out of pocket.
Nicholson was impressed with the service she received from the pharmacy, the product of a partnership between St. Joseph’s parent company, Dignity Health, and a specialty pharmacy integrator. In addition to securing financial assistance, the pharmacy helped with procuring the medicine, managing delivery and following up on care.
“The pharmacy made the medication totally accessible,” says Nicholson, 72. “Once I told them I couldn’t afford the medication, they said, ‘Don’t worry about it. We’ll let you know within 48 hours if we have a grant for you.’”
The cost of the medication illustrates the scope of the drug affordability barrier that patients confront every day, while the specialty pharmacy exemplifies the efforts initiated by hospitals and health systems to find solutions.
Skyrocketing prices lead to a search for answers
From 2006 to 2017, the average annual retail price of a brand-name drug in the United States increased by 264%, from $1,868 to $6,798. Prices climbed at double-digit rates annually from 2012 to 2016, peaking with a 15.9% spike in 2014.a A large part of the cost escalation has been due to specialty drugs, which are used to treat complex, chronic or rare conditions. Per capita spending on those drugs increased by 48% from 2013 to 2016.b