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High Drug Costs Limit Patient Access to Treatment, Medication

When drug prices increased, providers were less likely to prescribe the medication to patients, hindering patient access to treatment.

High drug costs hinder patient access to treatment.

Source: Thinkstock

By Sara Heath

- Rising out-of-pocket patient costs are keeping patients from using two common heart medications, hindering patient access to treatment, according to an analysis from the Cleveland Clinic.

Published as a letter to the editor in the most recent edition of the New England Journal of Medicine, the report claims that rising drug costs are keeping patients from accessing nitroprusside and isoproterenol.

The former lowers blood pressure and helps treat critical hypertension and congestive heart failure, while the latter mostly treats bradycardia and heart block. Neither drug has an entirely comparable alternative treatment, highlighting the importance that patients be able to access them, according to the researchers.

However, research shows that due to rising drug costs, clinicians are reluctant to prescribe these medications and patients are unable to access them.

“In our study, we identified large decreases in the utilization of nitroprusside and isoproterenol in response to very large price increases, changes that were not seen in the use of similar intravenous cardiovascular drugs with stable prices,” wrote Umesh N. Khot, MD, Eric D. Vogan, MSPH, and Michael A. Militello, PharmD, a trio of researchers from Cleveland Clinic.

“These findings refute the claim that price increases do not reduce patients’ access to these medications,” the three said.

During the test period between 2012 and 2015, both nitroprusside and isoproterenol costs increased significantly by a factor of 30 and 70, respectively. Nitroprusside increased from about $27 to $880, while isoproterenol increased from about $26 to $1,790.

As those costs went up, the number of patients using the drugs went down. Patient use of nitroprusside decreased by 53 percent between 2012 and 2015, while use of isoproterenol creased by 35 percent.

The researchers compared this use to drugs that are moderately comparable and that did not see cost increases during that time. Nitroglycerine and dobutamine correlated with nitroprusside and isoproterenol, respectively.

Nitroglycerine saw a price increase of only $12 between 2012 and 2015, while dobutamine actually saw a price decrease of about $1.

Those two “control” drugs saw significant more usage between 2012 and 2015. During that timeframe, 118 percent more patients used nitroglycerine and 7 percent more used dobutamine.

These findings are unfortunate because drug companies claimed that cost increases would not limit patient access to treatments, the trio argued.

“In public testimony, it had been stated that these price increases would not decrease patient access or utilization of these two critical drugs, both of which have been used for decades in patient care,” said Khot, who is also the vice chairman of cardiovascular medicine at Cleveland Clinic.

“However, our research shows that these price hikes are not benign,” Khot added. “Further research will determine if there has been any effect on patient outcomes, but it’s clear that utilization has been impacted.”

The researchers also suggested looking into strategies industry professionals are tapping to reconcile these soaring drug costs and patient medication access.

Other research has also found that rising drug costs have limited patient access to their medications. A 2017 report from Consumer Reports Best Buy Drugs found that 14 percent of patients do not fill their prescriptions because of medication costs.

One-quarter of patients are paying more for their medications than they did one year ago. Seventy-four percent of those patients said that they received no prior warning of a drug price increase, and 24 percent say they likely will not be able to continue paying for their medications in the future.

Unexpectedly increasing drug costs can be extremely burdensome for patients, even when patients do have the cash to pay for their medications. A drug price increase – especially a significant increase – requires a patient to adjust her budget. Not offering warning of these increases may keep the patient from being able to access that medication in the future.

Healthcare experts are currently working on solutions to the rising drug cost issue. Subsidizing prescriptions may be helpful. Additionally, regulations requiring drug companies and health payers to notify patients about increases in their financial responsibility may help ease cost burden.

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