- The rising cost of healthcare is a fundamental impediment to patient treatment access. As drug costs continue to climb, patients are seeing limited opportunity to access the medications and therapies necessary to overcome their health conditions.
Fourteen percent of patients have said that rising out-of-pocket drug costs have kept them from filling a prescription, according to a 2017 survey from Consumer Reports Best Buy Drugs. One-quarter of patients are paying more for their drugs currently than they ever have before, the survey showed.
Of the respondents who reported an increase in drug costs, 24 percent said those increases totaled at about $50 and 47 percent said cost increases were at least $20. Fifteen percent of price increases were as high as $100.
Perhaps most troubling is that three-quarters (74 percent) of patients said they did not receive prior notice before their medication costs increased. Cost transparency is crucial to ensuring patients can prepare to pay for their drugs, the experts noted.
Paying $40 or $50 for a medication is a far cry from filling a previously $10 or $15 prescription, the survey authors said. Patients seeing these price hikes need adequate time to adjust their personal budgets to ensure they won’t have to go without their medications.
A group of researchers from the Cleveland Clinic have likewise seen cost serve as a barrier to medication access. In a letter to the editor in the New England Journal of Medicine, researchers Umesh N. Khot, MD, Eric D. Vogan, MSPH, and Michael A. Militello, PharmD, reported that costs for two popular heart disease drugs (nitroprusside and isoproterenol) rose hundreds and thousands of dollars between 2012 and 2015.
“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 the trio of researchers.
After a price hike from $27 to $880, 53 percent fewer patients used nitroprusside. Thirty-five percent fewer patients used isoproterenol after it increased from $26 to $1,790.
The researchers did not remark on whether these price increases have had a negative impact on patient health outcomes, but further research will touch on those areas, the trio said.
Drug costs and medication adherence
Limiting patient access to medications creates a serious problem in chronic care management: medication non-adherence. Medication non-adherence can stem from myriad problems, but high drug costs is one of the most prominent. When patients cannot afford their medications, they cannot follow the medication regimens.
Medication non-adherence is an expensive problem for the healthcare industry because patients who do not take their medications run the risk of getting sicker or having a complex, acute, and costly medical episode. Figures from 2015 show that medication non-adherence results in nearly $8 million per 100,000 lives in healthcare costs annually.
Research has suggested that lower drug costs help patients remain more adherent to their medications. A 2017 study published in the Journal of Clinical Oncology found that access to Medicare Part D drug subsidies improved medication adherence rates in minority women who had undergone breast cancer surgery.
Seventy-seven percent of the study population received the drug subsidy, which improved medication adherence rates over two years for all racial demographics. Sixty-nine percent of black patients, 70 percent of Hispanic patients, and 61 percent of white patients had reached medication adherence by that point.
Those not receiving the Medicare Part D drug subsidy did not have nearly as large improvements in medication adherence, the researchers found. This is likely due to medication costs. Those receiving the subsidy only spent about $10 on their medications, while those not with the subsidy saw drug costs between $106 and $183.
This points to some potential policy changes, the researchers suggested.
“Our study supports the potential for policy interventions to improve equity in cancer outcomes,” the team stated. “The substantially higher persistence and adherence among women of all three race or ethnicity groups enrolled onto the Medicare D Low-Income Subsidy should lead to further efforts to ensure all eligible women are enrolled.”
Conversely, shifting cost-sharing amounts toward the patient has a negative impact on medication adherence, found separate research published in the American Journal of Managed Care.
Patients with better medication adherence spent more on their medications annually, the 2017 analysis of patients with diabetes showed. But when it came to overall medical spending, which included areas outside of drug costs, those with lower medication adherence accrued higher costs.
This suggested that increasing patient financial responsibility for drug costs was not entirely effective. Higher drug costs likely caused patients to be less adherent to their treatments, causing adverse health effects. The costs of medical intervention in those cases negated any savings seen due to cost sharing.
“If this cost-sharing trend continues, adherence may fall and any savings on pharmacy spending could be offset by increased medical spending,” the research team concluded. “Recent proposals to limit annual out-of-pocket spending for Medicare beneficiaries would reduce the financial burden on high-spend Medicare beneficiaries with T2D, potentially improving medication adherence and health outcomes.”
Industry action to limit, reduce drug costs
Individual clinicians can help their patients overcome drug pricing barriers by determining different regimens where possible. David Weinstock, MD, works with his patients to determine whether cost was a barrier.
“Patients don’t always like to admit that they’re having trouble with payments,” explained Weinstock, who is a primary care physician in Massachusetts.
“The way to overcome these barriers is by working with the patients. I usually ask them more than if they’re taking their pills,” he added. “I try to get a little more information from patients like if they’re taking pills, how they’re getting them, where they’re getting them.”
Once he discovers a cost barrier, Weinstock discusses more budget-friendly options with the patient. Certain pharmacies carry more generic medications than others, he explained. Weinstock will also prioritize certain medications if the patient’s financial situation is particularly dire.
Policymakers also have an integral role in reducing drug costs for patients.
Some states have introduced legislation to help chip away at the drug cost issue. In Washington State, a drug cost transparency bill has passed the House of Representatives and awaits debate in the Senate.
If passed, the legislation would call on drug companies to publicize any medication cost increases and offer a justification for those increases. Representative June Robinson, the bill’s sponsor, said this will help patients better prepare for high drug costs.
“When health care costs go up, you have to adjust your budget. But for far too many people, costs aren’t just going up; they’re skyrocketing unfairly and putting families in the position of not being able to get the care they need,” Robinson said in a statement. “This bill will provide the information we need to make sure that our healthcare isn’t compromised while drug companies maximize their profits.”
Widespread access to cost calculators and price transparency tools may also help patients better manage their out-of-pocket medication costs. However, the industry will ultimately have to address the root of the cost problem – medication costs are inordinately rising. When medication costs come under control, as will the high financial responsibility patients must assume for medications.