If the system isn’t entertaining a solution to decrease drug costs, a solution can be implemented to decrease medical costs which will decrease prescription costs. Dr. Barbara McAneny, CEO of the New Mexico Cancer Center, has demonstrated that it’s possible to decrease costs while improving patient care. Appropriately prioritizing care via comprehensive triage and treatment decision trees can decrease the number of costly Emergency Room (ER) visits. Also, aggressively managing side-effects of cancer drug therapies can aid in the decrease of ER visits. The more that cancer patients can avoid the ER, the better, since immune compromised cancer patients should not be around sick patients (McAneny, 2016). Extended clinician office hours can aid in patients seeking medication or emergency care. Prioritization, pathways, and extended office hours can get patients treated more effectively and timely which ultimately reduces costs.
According to the Lewin Group, there are several effective strategies that states can use to better manage and lower Medicaid drug costs: encourage generic drug use when appropriate, pay competitive market rates for drug dispensing, coordinate and tracking drug therapies, establish reimbursement rates for drug makers similar to what commercial drug plans pay, empower patients with control of some of the dollars spent on their drug therapies so that they become better consumers (Herrick, 2011).
Doctor and patients alone don’t have the power to influence market share. A few broad solutions to decrease cost and improve patient care include:
- Holding retail chains responsible for patient adherence
- Implementing value-based contracting with pharmacies
- Specialized pharmacy care to increase adherence and improves health outcomes
- Adding utilization management programs on formularies to decrease the cost to patients and insurers
There is a growing gap between a drug’s list price and the net price. This has been caused by closed formularies which increase member’s out-of-pocket costs (Gottlieb, 2017). The federal government is increasingly becoming a payer for prescription drugs. Washington can address the issues around drug pricing by increasing product and price competition. AARP suggests that the healthcare system can do the following to lower the cost of prescription drugs: let Medicare negotiate drug prices, allow more drugs to be imported, create transparency in drug pricing, provide for easier drug comparisons, implement value-based pricing (AARP Bulletin, 2017).
GoFundMe and other crowd campaigning websites have recently become necessity for life saving medical treatment. This is shown by the increase in GoFundMe medical campaigns. This social fundraising is obviously not meeting everyone’s need (Graham, 2017). This campaign mentality cannot be meeting every American’s financial, medical need. Lastly, the most successful patients in this arena were those that could describe their medical needs in not only a clear way, but in an interesting way.
Coupons for prescription drugs are sometimes hard to find, but they can be of great relief to struggling American families. Also, drug coupons can be a major headache for the average consumer. There are many laws and regulations surrounding these “coupons”. For example, patients enrolled in Medicaid plans cannot use prescription drug coupons. Also, patients enrolled in supplemental prescription insurance plans also cannot use prescription drug coupons. However, the sheer number of steps in the insurance billing process creates numerous holes where patients can actually use coupons while on Medicare: 6% of Medicare enrollees use coupons even though their use is banned (Frakt, 2017). The critic would say that prohibiting the average consumer from using coupons would cause public unrest, raise out-of-pocket expenses for a few people, force the masses to use generic drugs when available, and would reduce drug spending for everyone.
Though such coupons assist patients, they do nothing for insurers. By encouraging patients to switch from generic to brand drugs, coupons effectively impose higher costs on insurers. That ends up increasing premiums. Generic drugs are usually 80% cheaper than brand medications (Frant, 2017). Plans impose much higher cost-sharing for brand-name drugs to help keep premiums down without harming patients. According to a recent study examining data from 2007-2010, copay coupons increase use of brand drugs for which generics are available by 60% and spending by as much as 4.6% (Frakt, 2017). On the surface it may seem like prescription coupons are a good thing; they are good for individual patients, not for the general health system as a whole.
Some critics believe that drug prices should be controlled through government legislation. However, this has failed because most believe that price caps would lead to drug shortages or other unintended consequences (Los Angeles Times, 2017). The data companies release don’t provide much explanation for specific pricing decisions, such as why an EpiPen that sold for $104 in 2013 was priced at $225 two years later. The companies’ typical explanation is that every successful drug has to cover the cost of developing many other drugs that don’t make it to market. In addition to gathering data from insurers about which medications accounted for the most spending and what role prescription drugs played in rising insurance premiums, it would compel manufacturers to lay out the rationale for major price increases, along with documentation of any improvement in “clinical efficacy” that their drugs offer over alternative treatments. The same disclosures would be required for newly approved specialty drugs. The fact that pricing is complicated is all the more reason to develop a clearer picture of the factors involved. This issue is not going away. As drug prices continue to rise along with healthcare spending in general, so will the pressure on lawmakers to ease the pain.
AARP Bulletin. (2017). The Remedies: What can be done to lower drug costs. Retrieved from https://www.aarp.org/content/dam/aarp/health/healthy-living/2017/04/drug-prices-download-final.pdf
Frakt, A. (2017). When a Drug Coupon Helps You but Hurts Fellow Citizens. The New York Times. Retrieved from https://www.nytimes.com/2017/09/25/upshot/when-a-drug-coupon-helps-you-but-hurts-fellow-citizens.html
Gottlieb, S. (2017). What Lies Ahead? Perspectives on Healthcare Policy Reform. Pharmacy Benefit Management Institute. Lecture, Orlando, FL.
Graham, A. (2017). Health care costs driving more patients to crowdfunding sites. San Francisco Chronicle. Retrieved from https://www.sfchronicle.com/bayarea/article/Health-care-costs-driving-more-patients-to-12239305.php
Herrick, D. (2011). Increasing the Cost-Effectiveness of Medicaid Drug Programs. National Center for Policy Analysis. Retrieved from https://www.pcmanet.org/wp-content/uploads/2016/08/pa-dated-07-08-11-increasing-the-cost-effectiveness-of-medicaid-drug-programs.pdf
Los Angeles Times. (2017). Time to bring drug pricing into the light: Market for prescription drugs isn’t conventional, so we should stop pretending that normal rules apply. Retrieved from https://www.pressreader.com/usa/los-angeles-times/20170724/281672550006968
McAneny, B. (2016). Fighting Cancer. Cutting Costs. At the Same Time. Quality Talks 2016. Retrieved from http://www.qualitytalks.org/events/qt-2016/talks/fighting-cancer-cutting-costs-time/
Miller, S. (2017). Managing a Perfect Storm to Provide the Best in Cost Management and Patient Care. Pharmacy Benefit Management Institute. Lecture, Orlando, FL.