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.35 High prescription costs can further affect patients' ability to pay rent and other bills, and to purchase food.68

Despite the impact of prescription costs on adherence, most patients will not mention their cost concerns unless specifically asked.911 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.1213

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

KEY POINTS

  • 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

ABOUT THE AUTHORS

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Dr. Fiscella is a family physician and researcher in the Department of Family Medicine at the University of Rochester Medical Center (URMC), Rochester, N.Y....

Dr. Venci is a clinical pharmacy specialist in the URMC Primary Care Network.

Mechelle Sanders is a PhD candidate in health services research.

Angela Lanigan is research project manager for the American Academy of Family Physicians' National Research Network (NRN) in Leawood, Kan.

Dr. Fortuna is an associate professor in the departments of Internal Medicine, Pediatrics, and Community Health and associate medical director for quality and population health in the URMC Primary Care Network.

Author disclosures: no relevant financial affiliations disclosed.

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.

References

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1. Kirzinger A, Wu B, Brodie M. Kaiser Health Tracking Poll – March 2018: Views on Prescription Drug Pricing and Medicare-for-all Proposals. Kaiser Family Foundation. https://www.kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-march-2018-prescription-drug-pricing-medicare-for-all-proposals. Accessed April 2, 2019....

2. Kamal R, Cox C, McDermott D. What are the recent and forecasted trends in prescription drug spending? Peterson-Kaiser Health System Tracker; 2019. https://www.healthsystemtracker.org/chart-collection/recent-forecasted-trends-prescription-drug-spending. Accessed April 2, 2019.

3. Blanchard J, Madden JM, Ross-Degnan D, Gresenz CR, Soumerai SB. The relationship between emergency department use and cost-related medication nonadherence among Medicare beneficiaries. Ann Emerg Med. 2013;62(5):475–485.

4. Berkowitz SA, Meigs JB, DeWalt D, et al. Material need insecurities, control of diabetes mellitus, and use of health care resources: results of the Measuring Economic Insecurity in Diabetes study. JAMA Intern Med. 2015;175(2):257–265.

5. Kennedy J, Morgan S. Cost-related prescription nonadherence in the United States and Canada: a system-level comparison using the 2007 International Health Policy Survey in Seven Countries. Clin Ther. 2009;31(1):213–219.

6. Patel MR, Piette JD, Resnicow K, Kowalski-Dobson T, Heisler M. Social determinants of health, cost-related nonadherence, and cost-reducing behaviors among adults with diabetes: findings from the National Health Interview Survey. Med Care. 2016;54(8):796–803.

7. Naci H, Soumerai SB, Ross-Degnan D, et al. Persistent medication affordability problems among disabled Medicare beneficiaries after Part D, 2006–2011. Med Care. 2014;52(11):951–956.

8. Gill LL. How to pay less for your meds. Consumer Reports. April 5, 2018. https://www.consumerreports.org/drug-prices/how-to-pay-less-for-your-meds. Accessed April 8, 2019.

9. Wilson IB, Schoen C, Neuman P, et al. Physician-patient communication about prescription medication nonadherence: a 50-state study of America's seniors. J Gen Intern Med. 2007;22(1):6–12.

10. Alexander GC, Casalino LP, Meltzer DO. Patient-physician communication about out-of-pocket costs. JAMA. 2003;290(7):953–958.

11. Meluch AL, Oglesby WH. Physician-patient communication regarding patients' healthcare costs in the US: a systematic review of the literature. J Commun Healthc. 2015;8(2):151–160.

12. Alexander GC, Tseng CW. Six strategies to identify and assist patients burdened by out-of-pocket prescription costs. Cleve Clin J Med. 2004;71(5):433–437.

13. Rabbani A, Alexander GC. Cost savings associated with filling a 3-month supply of prescription medicines. Appl Health Econ Health Policy. 2009;7(4):255–264.

14. Carroll JK, Farah S, Fortuna RJ, et al. Addressing medication costs during primary care visits: a before/after study of team-based training. Ann Intern Med. In Press.

15. McGrath K, Hajjar ER, Kumar C, Hwang C, Salzman B. Deprescribing: a simple method for reducing polypharmacy. J Fam Pract. 2017;66(7):436–445.

16. Sinsky TA, Sinsky CA. A streamlined approach to prescription management. Fam Pract Manag. 2012;19(6):11–13.

17. Duru OK, Ettner SL, Turk N, et al. Potential savings associated with drug substitution in Medicare Part D: the Translating Research Into Action for Diabetes (TRIAD) study. J Gen Intern Med. 2014;29(1):230–236.

18. Gill LL. Save big with drug discount programs. Consumer Reports. June 18, 2018. https://www.consumerreports.org/drug-prices/drug-discount-programs-can-save-you-big-on-generics. Accessed April 8, 2019.

19. Van Nuys K, Joyce G, Ribero R, Goldman DP. Overpaying for Prescription Drugs: The Copay Clawback Phenomenon. USC Leonard D. Schaeffer Center for Health Policy & Economics; 2018. https://healthpolicy.usc.edu/wp-content/uploads/2018/03/2018.03_Overpaying20for20Prescription20Drugs_White20Paper_v.1-4.pdf. Accessed April 2, 2019.

 
 

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