Patient Responsibility News

Rising Out-of-Pocket Drug Costs Spur Patient Financial Woes

Fourteen percent of patients say rising out-of-pocket drug costs kept them from filling their prescriptions.

Rising out-of-pocket drug costs are hindering patient treatments.

Source: Thinkstock

By Sara Heath

- Out-of-pocket drug costs are growing, with 25 percent of patients paying more for their prescriptions now than they did one year ago, showed a survey from the Consumer Reports Best Buy Drugs.

The survey of 1,000 prescription-taking patients found that prescription drug prices are increasing at a steady rate, putting some pressure on patients’ pocketbooks. 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.

“Those are big, burdensome increases for nearly 28 million consumers with very little indication that the problem of rising costs will be solved anytime soon,” said Consumer Reports Best Buy Drugs Deputy Editor Lisa Gill. “Consumers are seeing significant out-of-pocket cost increases across the board – from generics to treat common conditions to newer drug therapies.”

Seventy-four percent of patients who saw a drug price or co-pay increase reported that they didn’t receive prior warning from their insurance companies. Limited drug price transparency can seriously hinder the patient, the survey authors explained. Paying $40 or $50 for a medication is a far cry from paying $10 or $15, and can serve as a financial barrier to treatments over time.

Healthcare payers are currently allowed to change prescription drug coverage, but they must give prior warning to beneficiaries before doing so, Consumer Reports said. In some states, it is also illegal to change drug coverage during a contract.

READ MORE: Top Strategies for Collecting Patient Financial Responsibility

Although increasing drug costs can be prohibitive to care, 37 percent of patients did nothing in response to their cost hikes. Thirty-five percent of patients asked their pharmacist or doctor for a less expensive drug and 22 percent asked for a lower price for the same drug. Twenty percent consulted with their health payer to negotiate better coverage for the drug.

Other patients looked to external cost-cutting strategies, such as using a discount coupon (17 percent) or shopping online (11 percent). Fifteen percent of patients shopped at another pharmacy for a lower drug price.

Fourteen percent of patients did not fill their prescriptions because of high drug costs. Going forward, 24 percent of patients said they aren’t confident that they’ll be able to afford their medications.

Clinicians and pharmacists can proactively work with patients to mitigate these drug cost issues by prescribing or offering the generic brand of a drug or suggesting a 90-day prescription, which tends to be more cost efficient.

Health payers can reduce patient sticker shock by offering more drug price transparency. One Washington State bill is working to require health payers in the state to be completely transparent when they must increase out-of-pocket patient costs for medications.

READ MORE: Lower Drug Costs, Subsidy Access Improve Medication Adherence

If passed, the bill will require that health payers and drug manufacturers warn patients about price increases and offer a justification for the cost increase. This will help patients when trying to budget their expenses.

“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,” said Representative June Robinson, the bill’s sponsor. “This bill will provide the information we need to make sure that our healthcare isn’t compromised while drug companies maximize their profits.”

The bill has moved to the Washington State Senate following its Senate approval.

In Maryland, lawmakers have restricted a payer’s ability to change drug coverage in the middle of treatment.

Often, payers will reduce coverage for medications, drop drug coverage, or backtrack and require a prior authorization for a certain medication. These actions can seriously prohibit a patient from accessing their medications.

READ MORE: Providers Struggle with Patient Price Transparency, Responsibility

Patients, especially those managing a chronic illness, often go to great lengths to select the most appropriate payer coverage for their needs, the Maryland bill’s sponsors said. When payers change the terms of a plan in the middle of a contract, patients must undergo an arduous and often time-consuming appeals process to regain drug coverage.

“It is simply unacceptable that health insurance providers can interfere with a patient’s treatment plan at any moment,” said Sharon Allison-Ottey, MD, Executive Director of the CoShar Foundation, one of the bill’s nearly thirty supporters. “We are thrilled that the legislature will take up this important issue to protect patients.”

 Since the bill’s introduction in February, it has been passed by the Maryland General Assembly. It will go into effect on July 1, 2017.


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