Drug prices are rising at a rate outpacing inflation – and they have been for more than a decade. That amounts to a major healthcare problem, given that cost is a common reason people don’t adhere to medication protocols and that nonadherence leads to about 10 percent of hospitalizations.
Put differently: systematically reducing drug costs will lead to better health outcomes at the population level. The question is: how can we do this in the absence of a complete overhaul of our healthcare system?
Pharmacists can play a major role by acting as expert consultants who help guide patients to the most cost-effective medications. But in most cases, they don’t have access to the tools and resources that would make it possible to deliver this kind of care at scale. What’s more, they’re rarely integrated into physicians’ practices and healthcare networks in a way that would maximize the impact of such care.
RxLive can solve for both. In this piece, I’ll explain how. First, I’ll lay out three things pharmacists can do to improve medication adherence by systematically lowering patients’ prescription costs, then explain how RxLive can help them do it and how physicians and healthcare networks can bring these tech-powered pharmacists onboard to improve outcomes throughout their patient populations.
Drug price reduction strategy 1: retail offsets
Whether substituting generics for branded medications, or connecting patients with retail programs to offset the price of their insulin regimen, reducing the cost of a patient’s prescriptions isn’t a one-step process.
It takes time to research the right option for each patient. And if physicians identify an effective, lower cost plan of care, patients will likely want to discuss the details of that change. For providers, that’s a challenge.
There’s not enough time in a 15-minute office visit to have this conversation, never mind for physicians to perform these calculations for all their patients during EOD charting sessions.
Pharmacists, on the other hand, are well positioned to recognize potential cost-saving options.
In many cases, pharmacists can identify coupons or retail programs that further reduce the cost of generic insulin. And pharmacists equipped with the right tools and resources can both point patients toward less expensive drugs and discuss these options with patients.
The more patients know about their drug regimen, the more likely they are to take their drugs correctly. So when healthcare teams are able to help patients understand the cost-saving changes to their medication regimens, they also offer value by increasing medication adherence.
But this is just one prong of what pharmacists can do. Let’s look at the other two.
Drug price reduction strategy 2: assistance programs
Many manufacturers offer patient / pharmaceutical assistance programs (PAPs). The same is true of states; Medicare maintains a database of state pharmaceutical assistance programs (SPAPs), which offer state-funded prescription assistance for specific drugs.
These programs can reduce drug costs significantly for patients, but they come with two big problems:
- Many people don’t know they exist.
- Applying for them is a hassle, especially if you’re on multiple medications and want to apply for assistance for more than one.
Pharmacists familiar with these programs can be hugely helpful by simply pointing people their way.
Even better: a pharmacist powered by programmatic tools pointing them toward use cases where an assistance program is available and likely to help.
In practice, for example, imagine a system that flags certain prescriptions to indicate whether a PAP or SPAP is available and, if so, provides a link to the necessary paperwork. A pharmacist could walk patients through these options during a phone call and send a follow-up message with the details to maximize the odds that patients get access to the financial assistance available.
Drug price reduction strategy 3: alternative pharmacies
Physicians are great at ensuring that they’ve got a patient’s preferred pharmacy on file – but few have any sort of mechanism for suggesting an alternate pharmacy based on pricing. And it’s almost unheard-of that anyone at a physician’s practice would have bandwidth to provide patients any kind of holistic counseling about drug prices.
For example: many consumers are aware that they can pay less for prescriptions by using apps like GoodRx. But many don’t realize that, because GoodRx provides a way to pay cash prices, the money patients spend doesn’t count toward their deductible or out-of-pocket max.
In other words, the short-term savings these platforms offer could actually translate to higher costs over the course of the year.
What cost-sensitive patients really need is someone who can crunch all the numbers and offer guidance around…
- When it makes sense to pay cash prices via something like GoodRx.
- When it makes sense to pursue generic alternatives (which also may not count toward insurance deductibles).
- When it makes sense to tap PAPs and SPAPs.
- When it makes sense to switch to an alternative dose or form.
- When it makes sense to shop at a pharmacy other than the patient’s primary pharmacy.
And, crucially, there is no “right” answer without patient input. A pharmacy one mile further from a patient’s home than their primary may make sense for a patient who drives everywhere but not for one without access to a car.
Saving $100 for four prescriptions may not be worthwhile if it means going to four different pharmacies to pick them up every month – especially for someone with limited mobility. Maybe a patient with eight prescriptions is able to make it to two pharmacies regularly; what’s the most cost-effective distribution of prescriptions for them?
Solving these problems can lead to cost reductions that greatly increase medication adherence and therefore reduce negative outcomes. Solving them at scale requires pharmacists to be powered by a platform like RxLive. Let’s take a look at how physicians can bring these solutions to their patients.
How physicians and healthcare networks can deliver lower medication costs to their patients
The key to making population-level drug price reductions work is finding a way to scale the kinds of interventions laid out above. That means any pharmacist a physician’s practice or healthcare network hires must have the tools and resources to identify cost savings opportunities for every patient practitioners see.
What’s more, the pharmacist has to have a plan for communicating with patients about which of their options make the most sense. RxLive facilitates all of this with a combination of technology and human expertise.
On the technology side, our platform is fueled by real-world data on drug costs, patient behavior, and nonadherence risk (plus EHR data) to highlight the patients and prescriptions most in need of cost-related intervention. It also includes comprehensive resources on available generics and current coupons so every pharmacist can deliver up-to-date recommendations and care.
On the human side, we offer practices and networks access to expert pharmacists on an as-needed basis. We achieve this with a fractional network of pharmacists. Practices and networks can supplement in-house pharmacists or rely fully on our network to deliver pharmacy-led cost management care to improve their patients’ drug adherence.
Of particular note: all of our pharmacists are fluent in best practices for managing drug costs. This can be especially valuable to practices and networks whose primary pharmacists have a clinical background, which focuses on conditions, medications, and interactions – but not cost. Adding cost management expertise makes it possible to deliver necessary guidance to patient groups for whom cost is a primary concern.
A robust solution for a complex problem
Cost-related nonadherence (CRN) isn’t just about patients not being able to afford their medication. In some cases, it’s a result of their perception of a drug’s cost. Or even their ability to access care. In other words, it’s a complex problem.
The cost-savings measures available to address this problem are also complex. To lower costs in a way that works for every patient, healthcare networks need a robust solution that makes it possible to scale personalized prescription-focused care.
RxLive does that by empowering pharmacists with data-fueled insights they can share with patients, customize with input from those patients, and translate to more affordable medication regimens that lead to better adherence and fewer adverse events – as well as providing on-demand access to tech-powered pharmacists themselves.For more information on how our platform helps practices and networks manage patient drug costs, get in touch.