How pharmacists can reply and help customers deal with drug costs
- The high and rising cost of prescription drugs is a topic getting plenty of attention.
- More than 80% of prescriptions are for generics and almost 75% of Americans taking prescriptions find them affordable.
- Almost 24% of Americans have not filled a prescription in the past year due to cost.
- The highest costs tend to be for specialty drugs for hepatitis C, cancer, MS, autoimmune disorders and orphan drugs.
- While rising costs are a real challenge for many patients, there are steps pharmacists can take to help, including: a Comprehensive Medication Review (CMR), assessing the drugs a patient is taking, speaking with their physician about alternatives, considering alternative drug plans, looking into patient assistance programs, and more.
Barely a day goes by without a media report of high and rising prescription drug costs. Drug costs are a source of anxiety for many patients, and a major campaign issue in this election cycle.
Kaiser Family Foundation asked people to identify health issues they thought should be top priorities for the president and Congress.
- The #1 issue was making drugs for serious diseases affordable.
- The #2 issue was lowering the cost of prescription drugs.
Based on significant price increases on some drugs and frequent media reports, this topic is top of mind for many consumers.
Some important facts
Speaking with patients about drug prices starts with being aware of a few basic facts:
- Most of the headlines have been about massive price increases from just a few companies, like Turing Pharmaceuticals, which raised the price of one drug overnight from $13.50 per pill to $750.1
- There is currently no government regulation of pharmaceutical prices in the United States. Developing a drug often takes billions of dollars in research and development (R&D), and drug companies set their prices to recoup their investment.
- In 2015 the list price for drugs rose about 12%, but in 2015 the net price (what is actually paid) rose just about 2.8%. This is a lower increase in net drug price than in prior years.2
- The most significant spending increases have been on specialty drugs, which accounted for two-thirds of the growth in pharmaceutical spending from 2010 to 2015,3 mainly on drugs for hepatitis C, cancer, multiple sclerosis, and autoimmune disorders, as well as orphan drugs.4
- The vast majority — more than 80% — of prescriptions in the U.S. are for generics. This means most prescriptions for most patients are less than $10.5
- The majority of Americans — more than 70% — find prescription drugs to be affordable.
However, for those patients struggling to afford prescriptions, especially those not taking generics and those taking high-cost specialty medications, rising prices are a real issue. In fact, 24% of respondents in a Kaiser Family Foundation survey said they or a family member did not fill a prescription in the past 12 months because of the cost.6
How pharmacists can help
Dealing with high-cost drugs is a difficult situation for many patients. But there are actions pharmacists can take to attempt to help. Ideas include:
- Conduct medication reviews. Pharmacists can assist patients by regularly reviewing medications. This review will make sure that patients are taking the appropriate medications for their condition. At times, savings can be realized if a patient can stop taking a drug that is no longer necessary or by adjusting a patient’s medications or dosage.
- Check with the patient’s doctor. At times, doctors prescribe medications out of habit, and may not be aware of the financial impact on a patient. For patients where a prescription presents a financial challenge, consult with their physician and even suggest alternatives, including generics where available and appropriate.
- Assist patients in reassessing their drug plan. Different drug plans cover different medications at different levels. Patients who fail to regularly review their drug plan options may be missing an opportunity to save hundreds or thousands of dollars per year. Pharmacies can help patients by providing Medicare Part D plan reviews. (See “Make This Year’s Open Enrollment Count.”)
- Look into patient assistance programs. Many pharmaceutical companies, especially those that provide high-cost drugs, offer patient assistance programs to help people with low incomes. Applying can take time, but the drugs are often free for patients. Pharmacists can help guide patients through the often complex world of patient assistance programs. Another alternative is a co-pay assistance manufacturer drug discount program. These programs offer drugs at a reduced cost.
Patient assistance program websites suggested by Consumer Reports:7
- Direct patients to applicable state programs and resources. Some states offer drug discount cards for individuals meeting age and income criteria. A site providing information about state programs is rxassist.org/patients/res-state-programs. Also, some states have programs, such as Medicaid, that might cover some or all of the cost of medications for qualifying patients.
Resources in Florida8
An example of a state with significant programs and resources to help individuals with the cost of medications is Florida.
- Prescription discounts are available for some Medicare beneficiaries.
- Florida Medicaid pays the cost of prescriptions for those who qualify (see www.myflfamilies.com).
- Sunshine for Seniors is a program for individuals 60 and older whose insurance does not cover prescription drugs (800.963.5337).
- Florida Discount Drug Card can help people save on prescriptions. Go to www.FloridaDiscountDrugCard.com.
Nationally, the Council on Aging has a website (www.BenefitsCheckUp.org) with referrals to programs that offer assistance with medication costs.
Drug costs are an important issue for many patients. But, there are several steps that pharmacists can take to educate patients, assist them, and direct them to resources that may be able to help.