Patient Responsibility News

Patients Support Efforts to Cut Out-of-Pocket Drug Costs for Seniors

Specifically, patients support policies to stabilize Medicare Part D, which could in turn reduce out-of-pocket drug costs.

out-of-pocket drug costs

Source: Thinkstock

By Sara Heath

- Patients largely support legislative measures that would stabilize the Medicare Part D program, stating that such measures could reduce rising patient financial responsibility and out-of-pocket drug costs, according to a Morning Consult poll conducted on behalf of the National Community Pharmacists Association (NCPA).

The survey of nearly 2,000 registered voters indicated that certain policies that work to reduce out-of-pocket drug costs for seniors are especially popular among constituents.

Specifically, respondents want to see pharmacy benefit managers (PBMs) play a smaller or less influential role in pharmacy affairs.

Patient respondents expressed interest in PBMs and healthcare payers passing drug discount savings onto seniors, with 93 percent of all respondents expressing such. Eighty-four percent of respondents said they want PBMs to stope charging retroactive fees for medications. Those retroactive fees often add to the growing out-of-pocket costs patients incur for their medications.

Ninety-two percent of respondents said seniors should be allowed to access medications at the pharmacy of their choosing, which could also reduce patient healthcare costs. This policy could encourage price shopping by allowing patients to purchase their medications from the least expensive provider.

Patients will largely reward Congressional candidates who run on these policies, the survey showed. Specifically, 75 percent of patients said they would support a candidate who voted to limit PBMs’ capabilities to charge retroactive pharmacy fees.

Respondents also said there should be more freedom in the pharmacist-patient relationship. Eighty percent of respondents said pharmacists should be allowed to tell patients about less expensive drug options, for example.

These survey results indicate patient sentiment for public policies regarding pharmaceuticals, according to B. Douglas Hoey, MBA, NCPA CEO.

"Healthcare issues ranked high among concerns in this nationwide survey of nearly 2,000 registered voters – and particularly concerns related to the Medicare Part D prescription drug benefit," said Hoey, who is also a pharmacist. “Respondents voiced strong concern about the perverse incentive pharmacy benefit managers have to raise drug prices, including retroactive fees PBMs charge pharmacies that have the effect of pushing Medicare beneficiaries more quickly into the coverage gap – the so-called 'donut hole' – and eventually into the catastrophic phase."

These concerns may be well-founded, as other evidence has indicated that healthcare and drug costs are rising for patients. A June 2018 Avalere report showed that Medicare Part D beneficiaries are paying more for generic prescription drugs, despite the fact that the market price for those drugs has remained unchanged.

This trend likely stems from the changing tier on which these drugs are placed in payer formularies, the analysis explained. Drug formularies are lists of preferred drugs for different health plans, in some cases determined by clinical effectiveness and value of the drug. Prescription drug cost and patient cost-sharing are a part of that value calculation in some cases.

More generic drugs are being placed on higher formulary tiers, meaning they are placed on tiers that will eventually cause patients to pay more out-of-pocket for the medication. Fifty-three percent fewer drugs were placed on the lowest formulary tier between 2011 and 2015, the report showed.

This shift in formulary placement ended up costing patients nearly $6.2 billion, a 93 percent jump in patient cost sharing during that four-year period.

Even patients are not paying directly out-of-pocket for their medications, they are seeing the costs elsewhere. A May 2018 analysis from America’s Health Insurance Plans (AHIP) showed that nearly one-quarter of patient spending on insurance premiums go toward drug costs. This means that, although not indicate of out-of-pocket costs, patients are still dedicating a considerable amount of their healthcare dollars toward prescription drug costs.

To its credit, federal policymakers reportedly want to cut patient cost-sharing. Earlier this year, the Trump Administration issued a blueprint for lowering drug prices for patients. Among other proposals, the blueprint called for better price transparency and potential amendments to the 340B program and Medicare Part D.

Since the publication of that blueprint, CMS has updated its drug price transparency dashboard that should help patients make informed decisions about their own healthcare purchasing options. HHS has also recently announced greater oversight of the 340B program to ensure hospitals use discounted prices for their intended use and pass on cost savings to patients.

However, critics of the blueprint say it raised more questions than answers and has offered limited insight into how HHS and CMS will tackle the rising drug cost issue.


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