Let's Fix It: Doctors and Patients Should Team Up to Demystify Prescription Drug Pricing

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When discussing the untenable cost of healthcare, we predominantly focus on physician office visits, procedures and hospital stays. You might be surprised however, to learn that medication (or the lack thereof) plays a significant role in the cost of healthcare.

According to the National Community Pharmacists Association's "Medication Adherence in America: A National Report 2013":

Non-adherence can threaten patients’ health individually as well as add vast costs to the health care system — an estimated $290 billion annually.

What is the rate of medication noncompliance?

In the Annals of Internal Medicine published by the American College of Physicians in April 2014, a study of 15,961 patients in a primary care network of 131 physicians in Quebec, Canada found that 31.3 percent of the 37,506 incident prescriptions written were not filled. Studies involving U.S. patients echo these results.

Medication noncompliance (or "nonadherence") has many causes and one of the most cited reasons in every study is the cost of the medication. The American College of Preventive Medicine has produced a resource to help physicians and other care providers improve medication compliance called "Medication Adherence Time Tool: Improving Health Outcomes."

It states:

Importantly, there cannot be barriers, such as cost, which will prevent medication access. The prescriber’s role is to gain trust from the patient, understand the patient’s belief system, find a way to treat within this belief system, interactively obtain agreement from the patient on when and how to take prescribed medication, and discuss cost issues to insure the medication is obtained and that instructions are followed. Building trust and developing skills for successful provider/patient communications demand time, effort, knowledge, and practice.

Am I really advocating for physicians to take on one more piece of uncompensated care?

Yes, I am. Consider this post from Arshya Vahabzadeh, MD published in March 2014 on KevinMD.com called "Be more involved in how patients fill their prescriptions." Dr. Vahabzadeh writes:

So here I am, having written thousands of prescriptions, but a relative novice in negotiating what my patients do with them afterwards. It appears that among physicians, I am by no means alone. The medications we prescribe are of little use if they are never filled or if patients are rationing them due to cost.

Solution: Software Development

ePrescribing software needs to be integrated with information about insurance plans and drug pricing. Most EHRs already have the ability to store insurance plan formularies, but physicians must be able to review with the patient what medication options are available and what each will cost based on the patient's insurance plan or lack thereof. Physicians must also be able to help patients by letting them know if they can get medications cheaper at different pharmacies. The patient deserves to know the full financial impact of the care, and the physician deserves to know if the patient will not follow through with the medication due to cost.

EHR vendors, take a look at RxRevu, a company that describes itself as "group of primary care physicians who research medications to provide you with the best cost alternatives to your current medications. Our technical team keeps health plans, retail costs and all medications on the market up to date."

Keep an eye on Polyglot, the amazing company who developed Meducation (we've written about them here) for some pretty innovative software called TimeView that allows physicians to see all patient prescriptions filled for all medications at all pharmacies.

Solution: Offer Value and Convenience

As consultants, we talk to our clients about providing value and convenience to their patients. Physicians are beginning (or returning) to offer in-house pharmacy services to their patients for the most-prescribed drugs for their specialty and patient population. Patients can receive their medications at the time of their office visit (convenience) and at a lower price available at the local pharmacy (value). Particularly for patients with transportation, time and childcare issues, compliance could be significantly improved with an in-office dispensary.

Solution: Incentivizing Medication Compliance

In the belief that our healthcare system is about to move from volume to value, patients being able to afford and take prescribed medication should be highly prized. Please, however, don't make it part of Meaningful Use!

Solution: Educate Patients About Choices

Give patients information on how to research costs for medications at different pharmacies and how to compare the costs with insurance vs. without insurance. Many patients do not know that they can opt to not use their insurance and pay the cash price. More and more patients are willing to put in the time to be better consumers of healthcare, including paying less for prescriptions. Physicians, however, have to be the ones to allow generic substitutes, write for a 90-day supply, consider pill-splitting, and offer medication vouchers or completion of medication assistance forms. These are exactly the kinds of strategies that will help patients afford and hopefully, take, their meds.

Disclosure: The author has no affiliation or relationship, financial or otherwise, with any company or product mentioned in this post.

Photo Credit: danielfoster437 via Compfight cc

Mary Pat Whaley is a Physician Advocate and Consultant who blogs at Manage My Practice. Her LinkedIn group of the same name, Manage My Practice, is for those interested in healthcare management.