II. Management: Lowering Patient Drug Costs
- Identify Generic Drug equivalent alternatives to expensive drugs
- Choose preferred medications from patient's insurance formulary
- If coupons and discounts expire for a pricey medication, consider less expensive alternatives
- Avoid prescribing longterm drugs with only shortterm coupons
- Consider drug assistance programs
- Consider for very expensive drugs (e.g. cancer Chemotherapy, monoclonal antibodies)
- See Medication Cost Assistance Program
- Consider Deprescribing medications with low efficacy or that are no longer indicated
- See Polypharmacy
- Evaluate Medication Adherence in chronic disease
- Noncompliance may be responsible for uncontrolled disease
- Adding another pricey medication may do little to improve disease control
- Prescribe 90 day supply
- May decrease prive and improve Medication Adherence
- Health savings account (HSA)
- Patients who have HSAs may use these to purchase medications with pre-tax dollars
- References
- (2024) Presc Lett 31(4): 22-3
III. Research: Studies
- Evaluation of 446 physicians surveyed
- Higher Prescribing Cost risks
- Pharmaceutical Representative exposure
- Group practice setting
- References
- Higher Prescribing Cost risks
- Direct drug advertising to healthcare consumers
- Appears to increase sale of drugs
- May result in inappropriate prescribing practices
- In 2017, Lyrica marketing cost $216 Million <5% of its over $5 Billion revenue for the year
- Mintzes (2002) BMJ 324:278-9 [PubMed]
- Pharmaceutical samples raise overall Prescribing Costs
- Poorest patients are the least likely to receive free drug samples
- Typical drug sample recipient has health insurance and lives far above poverty line
- Cutrona (2008) Am J Public Health 98(2): 284-9 [PubMed]
- In 2004, >25% ($16 billion) of drug company advertising ($57 billion) was spent on samples
IV. Background: Legislation
- Sunshine Act (U.S. regulation as of August 2013)
- Pharmaceutical Representative gifts over $10 are reported to a public list (with the provider's name)
- Prescription cost transparency (2019)
- New U.S. legislation in 2019 requires drug advertisements to include the wholesale cost of the drug
V. Resources
- No Free Lunch