Ever since the release of the latest Hepatitis C drug, which sells for $1,000 per pill, it seems there has been more attention than ever given to the often unaffordable price of some prescription medications. But it isn’t just the rare specialty medication that is pinching the pockets of the American public these days.
As reported by pharmacy industry expert Ed Silverman in a recent Pharmalot post, some commonly used and expensive brand name drugs are enjoying a virtual patent extension due to manufacturing difficulties encountered by the only approved generic.
The issue of “cost” brings drug therapy selection down to the most practical level of all. And it makes a difference. Numerous studies could be cited to show the correlation between adherence and affordability. When drug prices are so high that patients can’t afford their pills, nobody wins.
Retail pharmacists are in a unique position in the healthcare industry. Unlike most other providers, pharmacists conduct their trade on that tender line between the “best” therapy and what patients can practically afford to pay. They not only provide the product and the counseling to help patients get the most out of their medication, but they also stand nearby as those same patients (sometimes) painfully pull the bills from their wallet to purchase their pills.
They hear, at times, the shocked sounds of patients who didn’t expect the price staring at them on the digital register screen. And they often return to stock the prescriptions left abandoned at the pharmacy – at times due to the high price which the patient simply couldn’t afford.
There are many strategies to help lower the cost of prescription drug therapy for patients. Pharmacists, physicians and patients can work together to find affordable options. In my opinion, however, there are three tools in particular that deserve special attention:
·Internet drug coupons
·Free prescription discount cards and
·Formulary awareness
Internet Coupons
Internet drug coupons are downloadable savings certificates, which provide consumers with reduced copays or even free medication for a limited time frame.
For example, a patient being discharged from a hospital might be started on the new platelet inhibitor Effient® by Daiichi-Sankyo and Eli Lilly. Depending on the patient’s insurance, their initial fill might require Prior Authorization. An Internet coupon available from the manufacturer’s website would allow the patient to obtain a free 30 day supply to start, followed by reduced copayments for this medication in the months to come.
One website I visit often is internetdrugcoupons because they provide a convenient link to many coupons available from different brands. Note: there are sometimes restrictions which do not allow these coupons to be used in certain circumstances.
Free Prescription Discount Cards
Free prescription discount cards are available to consumers from a wide variety of sources. They are often on display in physician offices or available for free from organizations like AARP.
Many patients, and many professionals for that matter, are not familiar with how these cards work and are thus understandably skeptical. They are all run by different PBM’s. They provide consumers a discounted price (usually 15 percent to 85 percent) on medications not covered by prescription insurance. Uninsured patients can utilize them and sometimes enjoy substantial discounts (they even work for pets).
These companies collect a small fee from the pharmacy, which is deducted from what the patient pays. Some pharmacy chains have rules which discourage providing information about these cards to consumers. But many pharmacists I know keep them handy to help their patients afford medications they might not otherwise be able to purchase.
For an example of one such free card that can be printed immediately and used at most U.S. pharmacies, click here.
Formulary awareness
Finally, pharmacists can help patients save money on prescriptions by being aware of how formulary structures work.
Most health plans operate on a “tiered” basis in which generics are on the lowest tiers, and brand name drugs are in higher tiers. For most categories of drugs, there will typically be some drugs in the lowest tier, some at medium level tiers, and others at the highest tiers.
Tier placement is often a negotiated position that is worked out between a manufacturer and the health plan. Pharmacists who learn how to read formularies and research tier status can help patients with information they can bring their doctor about possible therapeutic alternatives.
One website available to help the public and health care employees monitor tier status is called Fingertip Formulary.
Pharmacists are in a unique position. They straddle the line where medication therapy meets the patient’s wallet. While we always want to recommend the best available prescription options, we have to be mindful that our patients are often living on a fixed income and are forced to choose between paying for pills and paying the bills.
Pharmacists can help their patients afford the medication they need, and in doing so prevent a sometimes forgotten drug interaction – the interaction with the patient’s bank account.
