Med­i­ca­tions can’t work if peo­ple don’t buy them

Doc­tors need info on costs when they write pre­scrip­tions

The Morning Call - - BUSINESS CYCLE - By Matthew Per­rone

— It’s the No. 1 rea­son pa­tients don’t fill their pre­scrip­tions — sticker shock.

While the price of al­most any good or ser­vice can be found on­line, most Amer­i­cans don’t know what they’ll owe for a pre­scrip­tion med­i­ca­tion un­til they get it. Un­ex­pected costs con­trib­ute to the es­ti­mated 20 to 30 per­cent of pre­scrip­tions that are never filled, which can lead to health prob­lems from un­treated med­i­cal con­di­tions.

“The best drug in the world isn’t go­ing to be ef­fec­tive if the pa­tient doesn’t take it,” said Dana Gold­man, a health econ­o­mist at the Univer­sity of South­ern Cal­i­for­nia, whose re­search shows that pa­tients have more trou­ble tak­ing their med­i­ca­tion as their costs rise.

“Doc­tors need to think about, not just what’s clin­i­cally op­ti­mal, but what’s op­ti­mal given the pa­tient’s fi­nan­cial cir­cum­stances.”

The fix sounds sim­ple: Give doc­tors in­for­ma­tion on pa­tients’ costs be­fore they write pre­scripWASHI­NGTON tions.

But com­pa­nies have yet to de­sign a sys­tem that can quickly an­a­lyze all the fac­tors that de­ter­mine what some­one will owe.

The ef­fort will soon get a push from the na­tion’s big­gest health care cus­tomer, the fed­eral gov­ern­ment. Un­der a Medi­care rule, com­pa­nies with pre­scrip­tion drug plans for se­niors must of­fer real-time pric­ing in­for­ma­tion by 2021.

Per­haps the big­gest hur­dle in cal­cu­lat­ing med­i­ca­tion costs is that doc­tors don’t know all the de­tails about a pa­tient’s in­sur­ance cover­age.

Nearly 40 per­cent of peo­ple who get their in­sur­ance through their em­ployer are re­quired to pay for part of their med­i­ca­tion, ac­cord­ing to an in­dus­try sur­vey. Many other pa­tients have de­ductibles, in which they are re­spon­si­ble for pay­ing all costs un­til they hit a set thresh­old. In those cases, pa­tients can bear the full cost of pricey med­i­ca­tions.

“Doc­tors of­ten have no idea what it might cost the pa­tient af­ter in­sur­ance, if they have in­sur­ance,” says Lynn Quincy of the non­profit health re­search firm Al­tarum.

Despite short­com­ings, pre­scrib­ing tools have come a long way since the days of pa­per pads.

Most ma­jor in­sur­ers and phar­macy ben­e­fit providers now of­fer cost-com­par­i­son in­for­ma­tion to doc­tors us­ing on­line pre­scrib­ing soft­ware. At a min­i­mum, doc­tors should be able to de­ter­mine if a med­i­ca­tion is cov­ered by a pa­tient’s in­sur­ance.

CVS Health re­ported last year that pre­scribers us­ing its re­al­time phar­macy ben­e­fit in­for­ma­tion saved pa­tients $130, on av­er­age, for every pre­scrip­tion they switched to a lower-priced, cov­ered drug.

But ex­perts say ad­di­tional fea­tures are needed.

Pa­tients can of­ten save money by not us­ing their in­sur­ance at all and in­stead pay­ing out-of­pocket for cheap generic drugs. In other cases, pa­tients can get bet­ter deals by us­ing coupons from drug­mak­ers or phar­ma­cies.

Those sav­ings are flagged on smart­phone apps like GoodRx but aren’t fac­tored into physi­cians’ pre­scrib­ing soft­ware. Even if they were, ex­perts say doc­tors don’t have time to help pa­tients fig­ure out the best place to fill pre­scrip­tions.

“That’s why we want to put this in­for­ma­tion in the hands of the con­sumer, so they can do some of that re­search and shop­ping around,” said Pooja Bab­brah, a health IT con­sul­tant with Point-of-Care Part­ners.

Bab­brah and oth­ers en­vi­sion a con­sumer-friendly app that pulls to­gether pa­tients’ pre­scrib­ing and ben­e­fit de­tails along­side lo­cal phar­macy prices and deals.

That has the po­ten­tial to im­prove med­i­ca­tion use for pa­tients, lower costs for in­sur­ers and free up ex­tra time for physi­cians.

But there are rea­sons to be skep­ti­cal. Most in­sur­ers of­fer price in­for­ma­tion on cer­tain med­i­cal pro­ce­dures, but stud­ies sug­gest only a tiny per­cent­age of pa­tients ever view it.

Sur­veys show Amer­i­cans are in­ter­ested in health care sav­ings but are also “very in­tim­i­dated by terms of in­sur­ance cover­age,” Quincy said.


Com­pa­nies have yet to de­sign a sys­tem that can quickly an­a­lyze all fac­tors that de­ter­mine what some­one will owe.

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