Discussions about drug pricing typically are not on the table during interactions between physicians and patients, even though many patients are known to struggle with the expense.
To encourage providers to address what some say is the “elephant in the room,” researchers at Vanderbilt University Medical Center developed a list of online vendors providing discounts and other selling options to lower one-time or monthly costs for patients. The compilation was published in an article in Urology Practice and has become a useful referral tool for clinicians.
“Stigma and embarrassment keep clinicians from discussing these matters.”
“Patients can’t have optimal outcomes if they can’t afford their medications,” said Ruchika Talwar, M.D., a clinical instructor of urologic oncology at Vanderbilt University Medical Center.
“We know that nine out of 10 patients want to discuss cost considerations with doctors, but there is stigma and embarrassment in bringing these topics up. We want people to be able to afford their prescriptions. Adherence leads to better outcomes.”
Resource for Sharing
The investigators found that one in four adults in the United States reports difficulty affording their prescription medication. They wrote that “high out-of-pocket costs are associated with low rates of adherence.”
Those struggling with unaffordable out-of-pocket costs include patients seeing a wide range of specialties, including cancer, psychiatry and urology, Talwar said.
The team’s report includes a one-page guide entitled, “Patient Guide for Purchasing Affordable Prescription Medications,” which offers convenient links and explanations for each platform.
The one-pager is meant to be distributed in waiting rooms and other public sites and potentially serve as a jumping-off point for conversations between patients and their doctors. The four platforms highlighted offer guidance for commonly encountered situations involving high-priced drugs or inadequate insurance coverage.
“We chose the most mainstream platforms, ones that have been out for a while and many people are already familiar with. We could have touched on many more,” Talwar said.
Price Transparency
Mark Cuban Cost Plus Drug Company, aka Cost Plus, is a direct-to-consumer pharmacy that offers complete transparency about its charges: the buyer pays the same amount Cost Plus paid the manufacturer, plus a 15-percent markup and $8 for shipping and handling. Cost Plus does not accept insurance.
Billionaire Cuban launched the site in 2022 with co-founder Alexander Oshmyansky, M.D., Ph.D., an American radiologist who first came up with the concept.
“The platform can charge much less because it bypasses the middlemen, the insurers’ pharmacy-benefit managers,” Talwar said. “It started out selling only generic drugs but has started adding brand-names, too.”
Some patients find that drugs are cheaper on the Cost Plus site than they are at a local pharmacy even after insurance benefits have been applied, Talwar noted.
“It’s shocking that patients pay less by completely foregoing their insurance benefits, but it’s just the way the system is,” she said, adding that the site is an especially valuable resource for patients with high-deductible health plans.
Local or Distant
“We included Amazon Pharmacy because the site is similar to the Amazon site, which so many people know and use,” said Talwar. Insured patients can input their plan information and compare the Amazon price to the estimated out-of-pocket cost remaining after they use their benefits.
“It’s different from many other direct-to-consumer pharmacies because it will accept insurance, which can be good for patients with low cost-sharing plans,” Talwar said. Just as Amazon can quickly deliver home goods and groceries, its pharmacy can speedily deliver prescriptions to a patient’s doorstep.
At GoodRx, patients who want to keep it local can input their medication information and choose a preferred location to authorize pickup at a nearby pharmacy. Many patients still prefer this traditional route, she noted.
“Also, there are many times that a patient needs their medication immediately and can’t wait for a mail order to arrive,” Talwar said.
GoodRx provides out-of-pocket estimates for retail prices and excludes insurance coverage estimates. This enables providers to strategically search the site for prescriptions that may be tripped up by insurance companies with preauthorization hurdles, the authors explain. Obtaining prior authorization is often an administrative burden for both patients and the doctor’s office staff.
“Prior authorization can be really difficult, especially with expensive cancer drugs and other essential medications,” Talwar said. “Patients can wind up not having full coverage, with high out-of-pocket costs.”
Part D Considerations
The vast majority of Medicare patients enroll in a Part D program, a voluntary prescription drug benefit for use in outpatient situations, the authors noted. Medicare’s online tool includes a Medicare Part D plan finder that allows patients to compare estimates of their out-of-pocket costs for their prescriptions under a variety of plans.
“Many people with Part D Plans aren’t aware that you have the ability to choose a plan that can minimize the cost for a specific drug,” Talwar said.
“Drug costs are becoming untenable. We have to do a better job of counseling in this regard.”
Each year, Medicare enrollees have an opportunity to change their Part D plans during the October 15 to December 7 open-enrollment window. Less than 30 percent of Medicare patients report using the tool to compare plans, according to a recent study.
Premiums are the same from one Part D plan to the next – $328 per month in 2023 – but deductibles and coinsurance may differ widely.
“These differences cause significant variation in out-of-pocket drug costs for patients,” the authors wrote, noting that patients can save thousands of dollars with the right plan.
Talwar added: “Drug costs are becoming untenable. We have to do a better job of counseling in this regard, despite the fact that our training never prepared us for these conversations.”
