How Doctors Can Help
Knowing whether or not a patient can afford his or her medications enables you to be proactive. Although physicians may not be able to solve a patient's financial problems, they can provide valuable guidance. Among the steps doctors can take:
Know the Resources Available to You
The medication assistance resources available to patients vary tremendously on the basis of a physician's practice setting, according to Kennedy. Physicians need to find out what programs are available and whether or not their facility is taking advantage of them. "There is a patchwork of programs," including patient assistance programs (PAPs) through drug companies and foundations, such as AmeriCares; drug discount programs, such as NeedyMeds, and the federal 340B program, which enables certain facilities to purchase drugs at the lowest prices possible.
Try Older Drugs First
"Are you prescribing the latest and greatest brand name drug when there is a generic available?" asks Dr Sagall. Doctors need to balance efficacy and affordability. Older drugs often achieve many of the same ends as newer incarnations, and are often much more affordable.
Consider Generics and Know Prices
"Everyone assumes that generics are cheap, but generic costs are skyrocketing," says Dr Sagall. If you frequently prescribe the same handful of generic drugs or mainstay treatments, have a sense of what they cost, he says. Prices can differ substantially from manufacturer to manufacturer and from pharmacy to pharmacy.
"A vial of insulin costs $150 to $170," says Sandra Leal, medical director of clinical pharmacists for the El Rio Community Health Center in Arizona, who specializes in diabetes management. "Providers are often shocked to hear that. Even with insurance, people have trouble affording that because of high deductibles and copays. Physicians need to talk to patients in real time about costs, rather than waiting months to find out they didn't fill a prescription."
Build Bridges With Pharmacists
Pharmacists are on the front lines. They interact with patients at a critical decision point: the cash register. They know drug costs; can see alternative mediations that may be included in an insured patient's formulary; and may know strategies that can help an uninsured patient reduce their costs, such as splitting higher-dosage pills in half. Increasingly, pharmacists are using such programs such as medication therapy management and appointment-based modeling to help patients better manage their prescriptions and potentially reduce the number of drugs they take. "If we can find a medication that has fewer side effects for a patient, we might be able to get them off of two or three other prescriptions," says Leal. "The dialogue is very critical among physicians, patients, and pharmacists."
Dr Filer agrees. "There isn't a lot of cost transparency in the healthcare system," she says. "I know what works, but I don't know what they are charging for it in the patient's pharmacy or how that price might fluctuate from month to month. I regularly receive messages from pharmacists saying, 'This is the cost of X. The patient can't afford it; can you prescribe an alternative?'"
Provide Patients With an Information Sheet
Because there are innumerable PAPs available and they are constantly changing, doctors can't keep up with all the programs. Still, physicians can provide patients with a list of resources where they can learn more. Some resources might include NeedyMeds or RxAssist, a site funded by the Robert Wood Johnson Foundation. Both provide information on PAPs, drug discount cards, and other information. The Partnership for Prescription Assistance, a site sponsored by Pharmaceutical Research and Manufacturers of America, provides information and enables users to access more than 475 public and private PAPs.
Learn From Your Patients
Often, low-income patients know about assistance programs available through churches and other community organizations, says Dr Filer. Knowing that information can help doctors help other patients.
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Cite this: Shelly Reese. Patients Not Taking Their Drugs? Ways You Can Change That - Medscape - Jan 21, 2015.