By MATTHEW PERRONE August 28, 2019.
WASHINGTON
(AP) — It’s the No. 1 reason patients don’t fill their prescriptions: sticker
shock.
While
the price of almost any good or service can be found online, most Americans
don’t know what they’ll owe for a prescription medication until they get it.
Unexpected costs contribute to the estimated 20 to 30 percent of
prescriptions that are never filled, which can lead to health problems from
untreated medical conditions.
“The
best drug in the world isn’t going to be effective if the patient doesn’t take
it,” said Dana Goldman, a health economist at the University of Southern
California, whose research shows that patients have more
trouble taking their medication as their costs rise. “Doctors need to think
about, not just what’s clinically optimal, but what’s optimal given the
patient’s financial circumstances.”
The fix
sounds simple: Give doctors information on patients’ costs before they write
prescriptions. But companies have yet to design a system that can quickly
analyze all the factors that determine what someone will owe.
The
effort will soon get a push from the nation’s biggest health care customer: the
federal government. Under a Medicare rule, companies with prescription drug
plans for seniors must offer real-time pricing information by 2021.
COST-SHARING
CONUNDRUM
Perhaps
the biggest hurdle in calculating medication costs is the fact that doctors
don’t know all the details about a patient’s insurance coverage.
Nearly
40 percent of people who get their insurance through their employer are
required to pay for part of their medication, according to an industry survey.
Many other patients have deductibles, in which they are responsible for paying
all costs until they hit a set threshold. In those cases, patients can bear the
full cost of pricey medications.
“Doctors
often have no idea what it might cost the patient after insurance, if they have
insurance,” says Lynn Quincy of the nonprofit health research firm Altarum.
IMPROVING
INFORMATION
Despite
current shortcomings, prescribing tools have come a long way since the days of
paper pads.
Most
major insurers and pharmacy benefit providers now offer cost-comparison
information to doctors using online prescribing software. At a minimum, doctors
should be able to determine if a medication is covered by a patient’s
insurance.
For
instance, CVS Health reported last year that prescribers using its real-time
pharmacy benefit information saved patients $130, on average, for every
prescription they switched to a lower-priced, covered drug.
But
experts say additional features are needed.
Patients
can often save money by not using their insurance at all and instead paying
out-of-pocket for cheap generic drugs. In other cases, patients can get better
deals by using coupons from drugmakers or pharmacies.
Those
savings are flagged on smartphone apps like GoodRx but aren’t factored into
physicians’ prescribing software. And even if they were, experts say doctors
don’t have time to help patients figure out the best place to fill
prescriptions.
“That’s
why we want to put this information in the hands of the consumer, so they can
do some of that research and shopping around,” said Pooja Babbrah, a health IT
consultant with Point-of-Care Partners.
PHARMACY
FUTURE
Babbrah
and others envision a consumer-friendly app that pulls together patients’
prescribing and benefit details alongside local pharmacy prices and deals.
That
has the potential to improve medication use for patients, lower costs for
insurers and free up extra time for physicians.
But
there are reasons to be skeptical. Most insurers offer price information on
certain medical procedures, but studies suggest only a tiny percentage of
patients ever view it.
Surveys
show Americans are interested in health care savings but are also “very
intimidated by terms of insurance coverage,” Quincy said.
“They
don’t really understand things like copays, coinsurance, deductibles and so
they may lack the confidence to make use of these complex tools,” she said.
The
Associated Press Health and Science Department receives support from the Howard Hughes Medical
Institute’s Department of Science Education. The AP is solely responsible for
all content.
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