Two strategies to help consumers lower drug costs

Prescription medications, including specialty drugs, now represent more than one out of five healthcare dollars, when looking at the average American benefit plan. That’s more than the costs for inpatient care (19%), and the drug share is rising. The frequently cited figure of 10% of total healthcare costs includes expenses for all care such as long-term care and many other personal care services not covered by employer and individual medical plans.

The good news is that when used as prescribed and sourced well, drugs improve health, quality of life and reduce medical complications, which in turn increases our economic productivity and lowers costs. 

However, studies show that half of all patients do not take their medications as prescribed and more than 20% of new prescriptions go unfilled. A top reason is cost. Doctors are not always in a position to know what a medication costs or whether there is a lower cost alternative brand name drug or a generic option available. That often leaves it to the patient to find the right drug at the lowest cost.

Fortunately, there are new tools that are making it possible for consumers to shop for the best value and receive helpful reminders to take and refill their prescriptions on time. They are:

1.    Online and mobile tools 

The ongoing migration to high-deductible health plans means more consumers will need these tools now and in the future. More than one-third of HealthPartners members (roughly 400,000) have a high deductible health plan and for the past several years it has been the fastest growing product design.

One challenge for consumers is that medication prices can vary significantly by pharmacy, even from pharmacy to pharmacy with the same retailer. Prices are negotiated differently by payer and also change regularly. These are some of the reasons why it’s difficult for patients, and their doctors, to know what they will pay when they get to the pharmacy counter.

Tools like drug cost calculators can help consumers to comparison shop. In addition to price, these tools show consumers how they can save money by ordering through mail order, by ordering a 90-day supply or with generics. However, they can be challenging to use. A new generation of easy-to-navigate web tools, include desktop search features and mobile apps with price comparison data and discounts. These are especially useful for people who do not have prescription insurance or who are in the deductible phase of their health plan and want to lower their out-of-pocket expenses.

HealthPartners is improving price information with a new web application being developed in partnership with GoodRx. When it is launched this summer, it will be available as an app on tablets, smartphones and desktop computers. The tool will provide information such as:

·      Real-time prices and out-of-pocket costs, based on their health plan benefits, at any contracted pharmacy in their current geographic area. The costs provided reflect the negotiated prices after discounts. They do not include rebates. 

·      Whether the medication is on the member’s health plan formulary.

·      If a generic or lower cost brand medication is available.

·      Their best choice for pharmacies based on their current medication use.

·      the ability to easily transfer prescriptions to another pharmacy with a couple of clicks.

Consumers will also see the cost to the health plan. Again, the costs provided are the negotiated price after discounts and do not include rebates. So even if a consumer might have a low copay, with no differential by pharmacy, they can still choose the lowest cost medication or pharmacy. By choosing the lowest cost drug to the health plan, consumers can help lower their health plan costs which in turn can help minimize premium increases.

Members who may fill a prescription when a lower cost was available will receive messages through email or letters to let them know where they can refill their medicine at a lower price.

Next: Another tool

2.    One-to-one medication support 

Filling and correctly using a prescribed medication and sourcing from a cost-effective pharmacy are key components of optimal medication use. Medication optimization also includes making sure that medication is working as it is supposed to, that side effects are minimized and that the regimen works with a patient’s preference and life style.

To address these factors, CMS requires Medicare Advantage health plans and Part D prescription drug plans to offer medication therapy management (MTM) to Medicare patients. These are one-to-one counseling sessions with a clinical pharmacist that are typically offered at no-cost to the patient on multiple medications. Some patients might need only one session to ensure that they are taking their medications correctly and there are no duplications or that there are no medications that might have negative interactions. 

This is particularly important for patients who are discharged from a hospital and whose medications need to be reconciled with what their regular doctor(s) have already prescribed. Patients who have chronic conditions and serious illnesses, might need on-going support to help with negative side effects, the cost of medications or managing the medication schedule.

HealthPartners MTM program proactively reaches out to their Medicare and commercial members, who could benefit most from this service. Pharmacists work with the patients’ providers. Overall, for about nine out of 10 patients, pharmacists find a need to change a medication, stop or start a medication, change the dose or suggest a medication that costs less. These changes prevent medical complications that improve the health and quality of life for patients, resulting in lower costs.

In a pilot program, high-risk patients who had been discharged from a hospital received a home visit from an MTM pharmacist. These patients had 10% fewer readmissions compared to patients who had no MTM visit. Overall, the average decrease in total costs for members who received MTM care was $1,600 annually. For the highest-risk members, that savings jumps to about $4,500. High-risk members include those taking seven or more medications, those who have diabetes or heart disease and other factors such as hospitalizations.

3. Policies that promote fair drug prices

While tools and support help consumers find the lowest cost medications, they do not address the underlying problem of prescription drug pricing. That is why HealthPartners is advocating for policy changes to make medications more affordable.

We support policies that increase transparency on what it costs to bring prescriptions drugs to market. We also support payment structures that reward drug companies fairly for bringing new drugs to market. In exchange for patent protections, drug companies should be required to launch and keep medications at a fair price.

Prescription drugs play a key role in achieving the Triple Aim to improve health, deliver a great experience and help make care more affordable. This can be achieved by empowering consumers with tools and support and with policies that promote transparency and fair pricing.

Scott Schnuckle is a senior vice president, pharmacy and business development at HealthPartners.