« November 2014 Issue

How Much Will that Prescription Drug Cost? I Really Can’t Say...

Consumers often face high out-of-pocket costs for prescription drugs each month, particularly people with chronic or multiple health conditions. Alarmingly, polls in 2012 and 2013 found that even insured consumers felt the financial burden of their monthly drug costs. When this monthly ‘cost burden’ gets too high, consumers will skip taking their medications, filling their prescriptions or even seeing their doctors – creating serious barriers to care.

In most aspects of their lives, consumers know how much something costs before they buy it. But when it comes to prescription drugs and other medical treatments, doctors, not patients, are in the decision-making driver’s seat. Yet physicians  – as well as patients – often lack reliable information about the actual cost of the drugs they prescribe. At the same time, doctors have not typically been trained or directed to make these choices based on a value assessment: the benefit of the medication to their patient relative to the drug’s cost burden on that patient.

Community Catalyst recently conducted a study to better understand the challenges physicians face in understanding drug costs, and in helping their patients address their out-of-pocket cost burden for prescription drugs. The authors also tested a potential resource that might improve how doctors and patients discuss drug costs.

To learn more about the findings of this valuable research, Spotlight talked to Wells Wilkinson, a staff attorney on Community Catalyst’s Prescription Reform team, who co-authored the study along with program director Marcia Hams.

Why is physician awareness of drug price and affordability an important issue to study?

Recurring evidence shows that many patients are having affordability issues with prescription drugs, even when they have insurance. Even worse, other polls suggest that nearly half of all consumers are too uncomfortable to raise this financial concern with their doctors or pharmacists, the trusted professionals in the best position to help.

At same time, there have been major developments in making drug price information more open and transparent. We thought that connecting doctors to this information could be important.

How did you conduct your study?

Because doctors play such a critical role in deciding which drugs patients take, we wanted to look at whether giving physicians easy access to drug price information could help them address their patients’ affordability problems. We surveyed 40 physicians who self-reported a moderate or high concern about their patients’ ability to afford their medications. We then surveyed them online.

What did you learn about physicians’ perspectives on their patients’ ability to pay for their medications?

We found serious problems, for both doctors and patients. The doctors estimated that 50 times a month, on average, they encounter a patient either taking fewer pills than they should, or not filling their prescriptions. Doctors also report spending more than an hour a day, on average, dealing with issues related to their patients’ ability to afford their medications. This includes everything from talking with patients about whether they can pay for their prescriptions, to fielding calls from pharmacies seeking a switch to a more affordable medication. Despite these clear concerns, half of the physicians surveyed found it difficult even to talk with patients about their ability to afford their prescriptions.

Why don’t doctors talk to patients about the affordability of their prescriptions?

When a doctor asks if a patient can afford a prescription, the first thing the patient asks is, “How much does it cost?” And frankly, doctors don’t know. They don’t have good resources to find accurate and timely information about how much drugs cost.

So, for the purposes of this study, we also designed and tested a model resource that could meet this need. Our model resource combines the actual current price of drugs at local pharmacies with unbiased recommendations of drug alternatives in a clear side-by-side comparison. This allows both doctors and patients to easily compare different drug choices, and different local pharmacies, by cost for specific items.

How did physician survey respondents react to this tool?

The response was overwhelmingly positive. Doctors really liked having comparative information about actual prices at local pharmacies, and they liked being able to easily see recommendations about alternatives. Nine in ten physicians said they would use such a resource frequently because it would save them time dealing with cost issues.

But the most important result was that doctors felt a resource like this would make it much easier to talk with their patients about whether drugs are affordable. And this would help ensure that their patients filled their prescriptions and took them correctly, without skipping or splitting pills.

What do you hope will happen as a result of this study?

We want price transparency tools like our model resource to be fully developed and made broadly available to doctors and patients. We would like doctors to be more cognizant of how their prescribing decisions can create a cost burden on their patients.

We also want to educate consumers, so they know where to turn for information when they are feeling the burden of their drug costs. We want to empower them to start conversations with their doctors about how much their care costs, whether it’s affordable and whether there are other options. We feel that to better capture quality and value in health care, both doctors and patients need to discuss cost and affordability when choosing prescription drugs.

Are there places physicians and patients can go now for better information?

Websites hosted by Community Catalyst, Consumer Reports Best Buy Drugs, and www.GoodRx.com are very good places to start.

What can our consumer advocate partners do about this issue?

Advocates can educate consumers and physicians about resources to help them find lower cost medications. They can help educate doctors about how cost and affordability issues are real concerns for many patients, and collaborate to create new models for patient engagement around drug affordability, adherence and value.

-- Kathy Melley, Director of Communications

O N   T H E   W I R E

Even in challenging environments, outreach and enrollment under the ACA was hugely successful last year. Community Catalyst’s  new video, Getting to Covered, tells the story of enrollment in three Southern States – Alabama, Florida and North Carolina. Thank you to everyone who worked to make the video a reality and to all the video participants. Special thanks to Jim Carnes with Alabama Arise, Ryan Morris with Florida CHAIN, and Nicole Dozier and Adam Linker with North Carolina Justice Center.

The New England Alliance for Children’s Health (NEACH) convened advocates from all six New England states at the 2014 Children’s Health Care Summit on November 12. NEACH celebrated this year’s Children’s Champion, Sandi Van Scoyoc, for her dedication to the health of children in New Hampshire and the true impact her work as president of the HNH Foundation created for them. Lieutenant Governor Elizabeth Roberts of Rhode Island spoke about her role as a child health advocate and the importance of such advocacy going forward.

More than 70 advocates, geriatrics provider experts, speakers and panelists attended the Voices for Better Health second annual Convening, held October 22 through 24 in Chicago, participating in sessions covering a wide array of topics central to the dual eligible demonstration projects. A highlight was the inspirational keynote address delivered by Marca Bristo, President and CEO of Access Living, Chicago’s center for independent living. Ms. Bristo helped draft and win passage of the ADA and is currently leading a campaign to promote the ratification in the United States of the UN Convention on the Rights of People with Disabilities.

Christine Barber, Senior Policy Analyst, and Eva Marie Stahl, New England Alliance for Children’s Health Director, explain to U.S. News & World Report how coverage options like the Children’s Health Insurance Program help children remain covered.

Dara Taylor, Director of the Expanding Coverage through Consumer Assistance Program in Missouri, explained successful strategies to engage the uninsured to enroll in coverage on KCUR 89.3FM.

Michael Miller, Director of Strategic Policy, discusses in the Washington Post the importance of hospital finance assistance, even as more consumers gain coverage.

Join us in welcoming new staff members: Sherry Dai, Sadie DeCourcy, Amber Ma, Trevon Mayers, Meredith Munn, Puja Patel, Jackie Rivera and Tory Stephens.

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