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A Doctor’s Perspective on Rx Drug Access and Affordability

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Dr. Holly Phillips

For me, one of the most fulfilling aspects of the practice of medicine is knowing I’ve helped patients make decisions that support their long-term health and longevity. One of the most frustrating aspects of medicine, on the other hand, comes when a patient is motivated to adhere to a treatment regimen, but simply can’t afford it. I know I’m not alone in dealing with this issue, as this frustration is unfortunately experienced by nearly all health care providers on a regular ­basis.

The perfect storm of spending and cost trends puts patients at risk. Unsustainable drug costs have long been a concern for the uninsured, but we’re starting to see this same issue among patients with health insurance. While the average deductible amount for single, employer-sponsored coverage was $1,505 last year, it is not unusual to treat patients that have $3,000, $4,000 or even $6,000 deductibles which apply to all medical costs — including their prescription drugs.

The days of low co-pays are certainly in the rearview mirror for many. In fact, more than half of patient out-of-pocket spending for brand-name medicines in 2017 was for prescriptions filled in the deductible or with coinsurance versus co-pays.

These increasing out-of-pocket costs certainly don’t seem to be slowing. Over the past decade, the total amount patients spent out-of-pocket grew, on average, from $525 to $806. That increase of 54% is higher than the increase in payments by health insurers, which rose 48%, on average, over the same time period (from $3,182 to $4,724).

Collectively, these issues are making it much harder for many people to afford their prescriptions. Americans spend around $1,200 per person on medications per year. Of course, that average includes healthy individuals taking no prescription drugs.

On the other side of that equation, specialty drugs can cost tens of thousands per month. These include drugs like the ones in new interferon-free, direct-acting, antiviral-based regimens for hepatitis C, which are priced at nearly $100,000 for a single course of treatment.

It only stands to reason that unaffordable prescriptions would have a detrimental impact on patient health. According to a recent survey by RetailMeNot RxSaver, a prescription discount program, and Kelton Research, high cost (61%) and lack of insurance (51%) were cited as the top reasons for not filling a prescription at all. A recent CVS Health study showed that during the course of a year, nearly one-third of its customers decided not to fill a prescription due to price.

The increase in cost share also has a direct connection to nonadherence and higher health care costs overall. Another study by RAND Corp. showed that for every $10 increase in co-payments, average compliance fell by 5 percentage points for cholesterol-lowering drugs. The study also showed that this lower compliance resulted in greater use of other expensive medical services, such as hospitalizations and emergency department visits.

Based on all of the above, it is no wonder that patients — and their physicians and pharmacists — are increasingly frustrated by their prescription spending. Yet there are some avenues available to help the individuals we serve, especially those with high cost share or a lack of health coverage. As essential parts of each patient’s care team, physicians and pharmacists should be knowledgeable about all of these resources, so we can quickly and easily educate patients about them.

According to Consumer Reports, there are several strategies that consumers can use to save on costs:

• Look for drug-specific patient assistance programs. While clinicians and pharmacists are usually familiar with these programs, many patients are not. Whether sponsored by drug manufacturers or nonprofits, these programs can be particularly helpful to offset the high cost of specialty and brand-name drugs. Do be aware that some of these programs have specific restrictions, especially for patients with insurance coverage.

• Find out about state-sponsored or Medicare savings opportunities. Some state governments offer discount cards with age and income requirements. For seniors, the Medicare Extra Help Program can help offset the co-pays required for prescription drugs. Even though these programs have been around for a while, awareness about them seems remarkably low.

• Consider other drug discount programs. While not available to Medicare members, other patients may benefit from pharmacy-sponsored discount cards and discounted drug lists, as well as savings programs like the one offered by RetailMeNot RxSaver, which can be used at any pharmacy. These programs are typically available to both insured and uninsured patients. As an added bonus, some of these programs also have prescription cost lookup tools.

Legislators and industry advocates strive to discuss solutions around reducing health care costs. But given that prescription drugs are still unaffordable for so many patients, physicians and pharmacists may find themselves dealing with this frustrating dynamic far too often. Those of us who go above and beyond in our patient interactions, whether they take place in the exam room or across the pharmacy counter, may find it useful to brush up on these resources. After all, we may be in the best position to take more immediate, meaningful action on this front.

Dr. Holly Phillips, a general internist, has maintained a private practice in New York for more than 15 years and has gained nationwide recognition as the medical contributor to CBS News.


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