[Automatically generated] From the JAMA Network, this is JAMA Clinical Reviews, interviews and ideas about innovations in medicine, science and clinical practice. Hello and welcome to our listeners from around the world to this JAMA Clinical Reviews podcast. I'm Anne Cappola, Senior Editor at JAMA, Professor of Medicine at the Pearlman School of Medicine at the University of Pennsylvania, and Director of the Penn Medical Communication Research Institute. Joining me today is Dr. Hussain Lalani. Dr. Lalani is a Primary Care Physician at Brigham and Women's Hospital and Instructor of Medicine at Harvard Medical School. He's a former Fellow at the Program on Regulation, Therapeutics and Law Portal at Brigham and Women's Hospital. We will be discussing the JAMA Special Communication, Strategies to Help Patients Navigate High Prescription Drug Costs by Doctors Lalani, Wang, Kesselheim and Rome. This special communication is part of JAMA's Health in the 2024 US. Election Series. Welcome, Dr. Lalani. Thanks so much for having me. Let's get on to talking about your really interesting piece. In it, you outline seven strategies to help patients afford prescription drugs. Can you tell us what those are? Absolutely. Hold on tight, because there's a lot to learn here. The first strategy is the Real-Time Prescription Benefit Tool. It's a tool that clinicians can use while they're prescribing a medication through the electronic health record to understand a patient's cost and coverage for a prescription drug. Strategy number two is a copayment card. It's a discount provided by brand-name drug manufacturers to lower out-of-pocket costs, specifically for privately insured patients. Strategy three is a patient assistance program. There's a few different flavors of these, but essentially, they lower out-of-pocket costs for patients. They provide drugs either free or at very low cost, and they're either offered by drug manufacturers or nonprofit organizations or foundations. Strategy four is a pharmacy coupon. These are like discounts on medicines that can be purchased at local pharmacies without having to use health insurance. Strategy five is a direct-to-consumer pharmacy, where you don't need a coupon at all. You can just directly purchase a drug from a pharmacy without using health insurance, and they tend to be lower cost for generics. Strategy number six is a public assistance program. These are programs that are for often low-income patients, and they provide drugs at reduced costs. They can be local, state, or even federal programs. And then finally, last but not least, Strategy seven is an international online pharmacy. Really a last resort option where you can purchase a drug directly from an international pharmacy and have it shipped to you. So that's a lot for a doctor and a patient to have to navigate. You also present an algorithm that you created to help clinicians match the appropriate one of the seven strategies to patients based on their health insurance and whether the drug is brand name or generic. Can you elaborate on this algorithm along with some examples of how a clinician could use this? Absolutely. It can be hard to navigate all these strategies and we're hoping that this algorithm will help simplify things. So let's say you have a patient who is prescribed eloquence or a pixaban, common blood thinner. The first step here in the algorithm is to use the real-time prescription drug benefit tool to see if that is the preferred drug on your patient's prescription drug plan. And assuming it is, you might get an estimate of how much it costs. Sometimes patients end up going to the pharmacy before they figure out how much the drug fully costs. So you'll have to figure out the next step, which is what type of insurance do they have. If your patient has private insurance, you might think about first, like whether there's another drug that you could prescribe that's just as good and will do the job. That could be, for example, Dabigatran in this case. But you might decide, well, you want to prescribe eloquence or a pixaban. And if your patient has private health insurance, the algorithm will recommend trying a manufacturer copayment card. And in that case, you could help your patient type in copayment card for eloquence into your favorite search engine. And you could pretty quickly sign up for a copayment card and use that at the pharmacy to lower out-of-pocket costs. That there's a lot of special terms and conditions to kind of help figure out just how much the drug will be discounted using a copayment card. But, if your patient has Medicare or is uninsured, the manufacturer copayment cards aren't really an option. And so, you could look for a public assistance program. And if the patient has Medicare, it could be something like the extra help program that your patient might be eligible for. Or a different patient assistance program through either the drug manufacturer or through a non-profit organization. And in our paper, we offer a bunch of resources in the table that can help you to access each of these different options. Finally, sometimes it might be a last resort here where a patient with Medicare, for example, may not be eligible for either a public assistance or a patient assistance program. And an international online pharmacy may be the best option if there are no other therapeutic alternatives. So in the case of a Pixaban, you could use Pharmacy Checker and to find a reputable international online pharmacy and have the patient purchase the drug directly from that pharmacy. And you'd have to fax in the prescription. So how much of this should be the clinicians' responsibility or the commission should try to do this? And how much of it is on the patient to try to navigate? That's a great question. Clinicians are busy. We have a lot to do. And we have a really short amount of time to do it. The good news is that many of these tools and strategies that we outline don't really require a clinician to actually operationalize every step of it. I think patients and families have a role to play. And even other clinical staff in your clinic or hospital can help. Generic drugs are supposed to be part of the solution to avoiding high drug costs. How much are high costs of generic drugs contributing to high prescription drug costs? So I think you're right that generic drugs are supposed to be part of the solution here. Often brand name drugs are the ones that cause the biggest affordability challenges for patients. But there are cases where generic drugs can be unaffordable. For example, if a patient is underinsured and has a high deductible health plan or if a patient is uninsured or if the drug plan just doesn't cover the drug at all. I think a good example here could be a drug like Tadalafil, a generic drug for Cialis, which is not covered by some insurance companies. The retail price is around $250 depending on the specific strength and quantity. In the algorithm, we recommend one of two options, either direct to consumer pharmacies or pharmacy coupons and using shared decision making to figure out which is the best option for your patient. So, for example, if the patient lives near a pharmacy and would prefer to pick up the medication the same day, you could visit GoodRx or SingleCare and find the correct pharmacy nearby and type in the drug name and see if you could find a pharmacy coupon that's far more affordable. Usually, there are options for this drug between $10 and $20. Another option could be a direct-to-consumer pharmacy. And in this case, you could find out whether your patient has an existing membership to Costco or Amazon Prime. Both of them have online and in Costco's case, in-person pharmacies that you could use as a direct-to-consumer pharmacy and purchase the drug also for around $10 or $20. The Cost Plus Drug Pharmacy by Mark Cuban is also another option. And it's primarily online only, but there's also an in-person option through the Team Cuban card. You've mentioned several online ways that patients can explore coupons or even finding their prescriptions. I'm guessing there have got to be scams out there that must be going along with this. And can you talk about the scams that you know of or how we can advise patients to avoid getting trapped in a scam while they're trying to get their prescriptions? Yeah, I'm so glad you brought this up. There is false information and really disinformation on the internet and on social media, where companies, pharmacies try to sell drugs, especially the really expensive brand-name drugs. I think it's come up more recently around the weight loss medications in the news. And it is really important to be careful. You know, I always advise my patients to work with their doctor, their medical provider when they're trying to get a prescription drug, and then to use a reputable pharmacy. So either pharmacy that you've been to before, that you trust. Any of the pharmacies in our paper are trusted and validated. And you can be assured that if you're using one of those, or one of those direct to consumer pharmacies, that you're in good hands. And if you go the International Online Pharmacy Route as a last resort, pharmacy checker has a really good verification tool, and they identify reputable, trustworthy pharmacies. So I've used that for my patients in the past when needed, and it works out pretty well. Great. Thanks. That's really helpful. You mentioned online international pharmacies a couple of times. And I was a little surprised when I looked at the article. I know that's option seven. It's not option one. But is it really okay for me to advise a patient to use an online international pharmacy? Yes. You know, it is a last resort option, but it is okay. You know, the Food and Drug Administration does allow patients to personally import prescription drug for themselves for up to a 90-day supply from an international online pharmacy. And, you know, it still is important to be careful and also to look and see if there is a domestic option that could be available and affordable. It's often much faster and easier to find a local option, but sometimes there may not be for a certain patient. And so something to have in your back pocket, especially for expensive brand name drugs. All right, that was really mainly all that I had. Is there anything that we didn't discuss that you'd like to raise? You know, this is a really important thing that we're talking about. Helping patients afford their prescription drugs ensures that the drugs actually work and that patients can get the benefit of the medication. And I really encourage everyone who's listening to use our tools. We wrote this publication for you, for clinicians, for your patients, for families. Print it out, use our algorithm, check out the tables. There's the pros and cons of every strategy there. And we hope it simplifies your life and the life of the clinical staff so that patients can affordably access their medications and hopefully benefit from them. I have one last question that has to do with the GLP-1 receptor agonist and the dual agonist out there, the weight loss medications. Any specific tips for that particular class of drugs? because there have been both shortages as well as just trouble with people being able to afford those. Any quick tips just related to that class of drugs? It's a really hard and sticky situation. I personally do not recommend using any of the compound pharmacies or online sites that are selling these drugs. But I do recommend working with your doctor if you're eligible and your insurance covers it. It's definitely a great option. Hopefully you can get it locally. The shortages, they tend to vary based on your region and based on the dosage of the drug itself. So no easy answers. Affordability is a problem. There are patient assistance programs and there are copay cards if you're eligible. So if you have private insurance or if you're very low income, those could be options. But it is a tough class of drugs to be able to access affordably for some patients, especially if you have Medicare or you're uninsured. Thanks to Dr. Hussain Lalani for joining us today to discuss his special communication, Strategies to Help Patients Navigate High Prescription Drug Costs. This is JAMA's Senior Editor, Dr. Anne Cappola. To follow this and other JAMA Network podcasts, please visit jamanetworkaudio.com. You can also listen and follow wherever you get your podcasts. This episode was produced by Daniel Morrow. This content is protected by copyright by the American Medical Association with All Rights Reserved, including those for text and data mining, AI training and similar technologies.