Overview
The podcast discusses seven strategies for helping patients manage high prescription drug costs, details an algorithm to guide selection based on insurance and drug type, and provides practical advice for clinicians and patients navigating affordability, particularly for challenging drug classes like GLP-1 receptor agonists.
Seven Strategies to Reduce Prescription Drug Costs
- Real-Time Prescription Benefit Tool helps clinicians check drug costs and coverage in the electronic health record.
- Copayment cards lower costs for privately insured patients using brand-name manufacturer discounts.
- Patient assistance programs offer free or low-cost drugs, provided by manufacturers, nonprofits, or foundations.
- Pharmacy coupons can be used at local pharmacies to access discounts without insurance.
- Direct-to-consumer pharmacies allow drug purchases without insurance, often cheaper for generics.
- Public assistance programs offer reduced drug costs for low-income patients through local, state, or federal initiatives.
- International online pharmacies are a last-resort option for purchasing drugs from abroad and importing them for personal use.
Algorithm for Clinician Use
- Clinicians should first use the real-time benefit tool to estimate a patient’s drug cost and check coverage.
- Choice of strategy depends on the patient’s insurance (private, Medicare, or uninsured) and whether the drug is brand-name or generic.
- Copayment cards are primarily for privately insured patients; public assistance and patient assistance programs are alternatives for Medicare or uninsured patients.
- For generics with high costs and limited insurance coverage, pharmacy coupons or direct-to-consumer pharmacies are recommended.
- International online pharmacies are only recommended when no other affordable alternative exists.
Practical Considerations and Division of Responsibility
- The responsibility for navigating these options can be shared between clinicians, patients, families, and clinical support staff.
- Many strategies can be accessed independently by patients, reducing clinician burden.
Risks and Safeguards: Scams and Online Pharmacies
- Patients should use only reputable pharmacies and verification tools (like Pharmacy Checker) to avoid scams or counterfeit drugs.
- It is critical to collaborate with healthcare providers when seeking medications from less conventional sources.
Special Drug Classes: GLP-1 Receptor Agonists
- Patients are advised to avoid compound pharmacies or unreliable online sources for these drugs.
- Insurance coverage or patient assistance programs may help, but access remains limited, especially for Medicare or uninsured patients.
Recommendations / Advice
- Use published tools and algorithm tables to simplify and optimize drug access decisions.
- Check both domestic and international options, but prioritize local, reputable pharmacies whenever possible.
- Employ shared decision-making to identify the best cost-saving strategy for each patient’s circumstances.