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Medication Costs Are Preventing Your Patients from Getting Treatment

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Medication Costs Are Preventing Your Patients from Getting Treatment

Prescription drug prices in the US are nearly three times higher than in other countries, and they continue to rise. From January 2022 to January 2023 alone, prices of over 4,000 drugs increased, with almost half exceeding the inflation rate. This has led many Americans to forgo medical treatment altogether.

There are several factors contributing to rising prescription prices, leaving both healthcare providers and patients feeling helpless. But what if I told you, you’re not? As a prescribing clinician, you have more power in this matter than you may realize.  

Reasons for Rising Prescription Prices

Many factors contribute to the rising prescription drug prices in the US. However, some may surprise you:

Pharmaceutical Industry Dynamics: Drug companies invest heavily in research and development (R&D) to bring new medications to market. While this is commendable, recouping these costs often translates to high initial prices and subsequent price hikes. Additionally, the patent system grants pharmaceutical companies exclusive rights to produce a drug for a set period, limiting competition and allowing them to control pricing.

Lack of Transparency: The drug pricing process is often shrouded in secrecy. Wholesalers, pharmacies, and pharmacy benefit managers (PBMs) all play a role in the final price a patient pays, but the specific markups each entity adds are often unclear. This lack of transparency makes it difficult to identify where price inflation originates and hinders efforts to negotiate lower costs.

Evergreening Strategies: Sometimes, pharmaceutical companies employ tactics to extend patent protection beyond the initial expiration date. This can involve making minor modifications to existing drugs or finding new uses for them. While these changes may offer some benefit, they can also be a way to maintain high prices without introducing competition or truly innovative medications.

Marketing and Direct-to-Consumer Advertising: Drug companies spend billions of dollars marketing their medications directly to consumers. While this can raise awareness about treatment options, it can also create a perception of a drug’s value that isn’t necessarily tied to its actual clinical benefit. These marketing expenses ultimately get factored into the price patients pay at the pharmacy.

Political Influence: Pharmaceutical companies invest heavily in lobbying efforts to influence legislation and regulations that govern drug pricing and development. This can include advocating for policies that extend patent protections, limit competition from generics, or weaken price negotiation power for government agencies like Medicare.

Seriousness of the Disease: This one might be the hardest to hear, but the severity of the disease being treated by the medication can also impact its price. For more serious conditions where medication is necessary to maintain the quality or length of life, companies are able to charge a higher price because they know that patients and their families will buy it out of necessity.

Strategies to Lower Prescription Costs for Patients

Pharmaceutical companies might have workarounds for raising prices, but as mentioned, you and your patients aren’t helpless.

Have you heard of clinical decision support (CDS)? CDS consists of various tools that help clinicians prescribe medications more easily and safely. Some examples of commonly used CDS tools are automatic drug-to-drug interaction checks and allergy alerts, which can alert clinicians of potential risks before they finalize a prescription. However, the CDS tools we’ll focus on today are real-time benefits checking and formulary coverage information, which are tools aimed at improving treatment and medication adherence.

Real-Time Benefits Checking

Real-time benefits checking (RTBC) is a game-changer in the fight against rising prescription drug costs. When you prescribe a medication, RTBC automatically retrieves your patient’s specific insurance information. This offers:

  • Instant Cost Transparency: It displays the estimated out-of-pocket cost for the prescribed medication alongside potential lower-cost alternatives covered by the patient’s insurance plan. This allows you to identify medications that are within a patient’s budget, potentially preventing them from skipping or rationing their medication due to cost concerns.
  • Informed Collaboration: This real-time information empowers you to discuss cost considerations with your patient at the point of care. Together, you can explore options that are both clinically effective and financially feasible.
  • Streamlined Workflows: This process also reduces administrative burden for you and your staff, eliminating the need for time-consuming phone calls or manual checks to verify insurance coverage and costs.

Formulary Coverage Information

Formulary coverage information is another crucial CDS. A formulary is a list of medications that are covered by a specific insurance plan. This list is typically categorized into tiers, with each tier having a different associated cost:

  • Tier 1: These are typically generic medications with the lowest co-pays or coinsurance amounts.
  • Tier 2: This tier may include brand-name drugs or generics with higher co-pays than Tier 1 medications.
  • Tier 3: This tier typically includes specialty medications with the highest out-of-pocket expenses for patients.

Formulary coverage information helps you understand:

  • Prior Authorization Requirements: Some medications may require prior authorization from the insurance company before being dispensed. This tool can alert you if this is the case, saving you and your patient valuable time by avoiding potential delays in treatment.
  • Therapeutic Alternatives: Similarly to RTBC, the formulary may suggest therapeutic alternatives to the initially prescribed medication. These alternatives may be covered under a lower tier on the formulary, potentially reducing the patient’s out-of-pocket cost.

How to Access These Tools

Due to growing use, some electronic health records (EHRs) have integrated CDS tools into their software, allowing clinicians immediate access. However, many EHRs still struggle to build these tools within their software due to the costs associated with research and development. In those cases, many clinicians opt to integrate these tools into their workflows through one of the following methods:

  • Integrate CDS into your existing EHR: You likely already have an EHR that you use for patient and practice management. Don’t worry, you don’t have to switch software to access these tools. NewCrop’s e-prescribe software directly integrates with your EHR, giving you access to all its robust features, right from your existing workflows. These features include the CDS tools mentioned above (and then some), plus electronic prescribing, EPCS, PDMP, and more.
  • Use a standalone CDS tool: If you don’t currently use, or are in between EHRs, another option is to implement CDS as a standalone option using e-prescribe software. You can access all the same benefits mentioned with an integration, but you would work directly from the e-prescribe solution. Then, should you implement a new EHR in the future, you can still choose to integrate.

Additional Strategies for Lowering Prescription Costs

While clinical decision support (CDS) offers the most comprehensive solution to lowering prescription costs for patients, there are some additional strategies you can implement:

  • Generic Medications: Always explore the possibility of generic alternatives when prescribing. Generics offer the same active ingredients as brand-name drugs but at a significantly lower cost. Discuss this option with your patient and address any concerns they might have about switching medications.
  • Discount Programs and Coupons: Several resources offer discounts or coupons on prescription medications. You can search for these online or ask your local pharmacy about available programs. Some drug manufacturers also offer patient assistance programs for specific medications.
  • 90-Day Prescriptions: When appropriate, consider prescribing a 90-day supply of medication instead of a 30-day supply. This can sometimes lead to lower overall costs and improve medication adherence for your patients.
  • Sample Prescriptions: Pharmaceutical companies may offer free samples of new medications. Utilize these samples strategically to allow patients to try a medication before committing to a full prescription.
  • Over-the-Counter (OTC) Alternatives: For certain conditions, there may be safe and effective OTC alternatives to prescription medications. Discuss these options with your patient, keeping in mind the potential for side effects and interactions with other medications.

The Best Way to Prescribe in 2024

With the continuous rise in healthcare costs, substance misuse, and adverse drug events, there is an immediate need for change in healthcare delivery. While e-prescribing was once a luxury for clinicians and patients, it is now a must in patient-centered care.  E-prescribe offers sustainable solutions to the mentioned healthcare issues, providing tools to mitigate costs, combat the opioid crisis, and improve prescribing safety.   

NewCrop’s industry-leading tool goes above and beyond, with gold-standard certifications and advanced features not found in most EHRs. If you don’t currently have access to a robust e-prescribe tool, schedule a demo of NewCrop to see the difference it can make.

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