A Practical Approach to Reducing Patients' Prescription Costs
A single screening question and an arsenal of cost-reducing strategies can help you help your patients afford their medications.
Fam Pract Manag. 2019 May-June;26(3):5-9.
Author disclosures: no relevant financial affiliations disclosed.
Patients are increasingly concerned about growing out-of-pocket prescription costs.1 In 2017, the United States spent $1,025 per capita on prescription drugs.2 High prescription costs are a leading reason why patients do not take their prescribed medications, resulting in avoidable emergency department visits and hospitalizations.3–5 High prescription costs can further affect patients' ability to pay rent and other bills, and to purchase food.6–8
Despite the impact of prescription costs on adherence, most patients will not mention their cost concerns unless specifically asked.9–11 Instead, patients tend to engage in a range of cost-saving strategies such as not picking up a prescription or skipping doses to conserve quantities.6 The clinical ramifications of these behaviors are significant, and identifying these patterns is essential to successfully managing chronic diseases. Fortunately, feasible office-based strategies exist to assist patients in reducing their medication costs.12–13
Herein, we present a practical approach to screening and management of patients' cost-related medication concerns. We piloted this approach in seven primary care practices and found that it doubled discussions of patients' out-of-pocket prescription costs and was viewed as useful by patients, clinicians, and staff.14
High prescription costs are a common reason for medication non-adherence, but most patients will not mention their cost concerns unless specifically asked.
Screening patients for prescription cost concerns can be accomplished with a single question.
All staff members can play a meaningful role in addressing cost-related medication nonadherence, and each role should be clearly identified in your practice's workflow.
STEP ONE: HAVE YOUR STAFF CONDUCT A ONE-QUESTION SCREENING
Screening patients and then addressing their prescription cost concerns should be a team effort, analogous to depression screening and treatment. Having staff handle the first step, the screening, reduces the burden on the physician and engages key team members in the office. Practice staff are frequently more involved with patients' prescription cost concerns than physicians realize. Patients often share information with reception and nursing staff through phone messages and refill requests. Moreover, some patients may be more apt to share information about their nonadherent behaviors with nursing or other office staff than with their physician. We learned from our pilot that staff often want to help, and there is a meaningful role for all staff members in addressing cost-related medication nonadherence.
Identifying patients who have prescription cost concerns requires s
The authors acknowledge the contributions of Jennifer K. Carroll, MD, MPH, in conducting and evaluating a pilot of this approach among NRN practices.
Funding support: The study that is the basis for this article was funded by the Robert Wood Johnson Foundation grant No. 74124.
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