Picking up a prescription medication at the pharmacy is often a surprise — in most cases, nobody tells you how much it’s going to cost before the pharmacist actually rings it up. You can be pleasantly surprised by a $5 co-pay or shocked by an out-of-pocket expense of hundreds of dollars.
“Very few health care providers actually know the costs associated with the medications they prescribe and provide that information at the point of care,” said
Jonathan Watanabe, PharmD, PhD, assistant professor of clinical pharmacy in the Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego and board-certified geriatrics pharmacist. “At the moment, the burden is on patients to figure it out for themselves.” Watanabe is also a National Academy of Medicine Anniversary Fellow in Pharmacy, where he serves on a committee that seeks to improve patient access to affordable therapies. One of the committee’s goals is to find better ways to inform patients about drugs costs.
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Cost is frequently cited as a reason patients never fill a prescription, or don’t take their medications consistently. According to a 2012
Public Health Reports article, 75 percent of Americans don’t take their medicines as directed. This lack of adherence leads to an estimated 125,000 deaths per year, as well as billions of dollars wasted on avoidable health care costs.
What’s a patient to do?
Price comparison apps
Several consumer apps have popped up recently that claim to help you take the guess work out of prescription medication costs, and comparison shop before you buy.
“The technology is improving,” Watanabe said, “but at the moment, most of these apps don’t incorporate insurance coverage. Without that, they’re sort of meaningless because most new prescription costs and now even many older medication costs are sky high without insurance. And even if your health insurance company provides information to the app, it still might not be accurate because they typically use aggregate information, while you may have a specific pharmacy benefit.”
That being said, prescription cost comparison apps can be helpful if you only want a general idea of how relatively expensive a particular drug might be.
“If a drug looks very expensive on the app, even if that particular dollar amount may not be totally accurate, it likely signals that it will be pricey even with co-pay,” Watanabe said.
Do your research
Apps aside, Watanabe says there are a few steps patients can take to get a handle on prescription drug costs.
For patients with health insurance plans that include pharmacy benefits, many have searchable lists on their websites that can help you determine whether or not your medication is covered and the co-pay you can expect.
For patients without pharmacy benefits, Watanabe recommends looking into generic medication programs run by a few major retailers. Alternatively, independent pharmacies might charge less when a patient is paying out of pocket.
Talk to your doctor or pharmacist
What Watanabe would most like to see is clinicians helping patients at the point of care. He says there are several companies now developing platforms to help health care providers look up a patient’s insurance plan, see what’s covered and prescribe accordingly — all while the patient is still in the room.
“That way, a patient and doctor can work together to find a medication that’s affordable, yet still effective,” he said. “If the choice can be made right there in the exam room, it will save the patient a ton of time and effort, and hopefully make it more likely that prescription will be filled.”
Watanabe first became interested in these efforts when he learned that several large studies have shown that in many situations more effective, less costly medications are being prescribed far less often than less effective, more costly drugs.
Still, some prescribers are not yet aware of drug costs and are not comfortable talking to patients about it. A 2003 survey published in the
Journal of the American Medical Association found that 90 percent of the physicians believed they should consider their patients’ cost burden. However, 85 percent of the patients reported they had never discussed medication costs, even though 73 percent of them also said they had not taken medications as prescribed in the past year due to cost.
Watanabe recommends starting that dialogue with your doctor or clinician yourself, asking questions such as “Is this going to be covered by my health insurance?” or “Do you know of any discount programs for this medication?”
“It’s more efficient to do your own research and have that discussion up front, rather than have to go back and try to get ahold of your doctor again later to possibly find a less expensive alternative,” he said.
If you’ve already left the doctor’s office, pharmacists are also a great resource for information on drug costs and alternatives. In fact, to improve cost-conscious medication use for seniors, Medicare Part D enrollees must be offered a plan-sponsored, face-to-face comprehensive medication review by pharmacists at least annually, if they meet criteria for high expected medication costs and use multiple medications for multiple conditions.
“Wherever it takes place, these types of discussions are important because we know that costs influence patient adherence to medications and ultimately the clinical outcomes,” Watanabe said.
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