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    By Matthew McAuliffe, medical student, Kansas City University of Medicine and Biosciences, Joplin, Mo.; Brandon Tompkins, medical student, Kansas City University of Medicine and Biosciences, Joplin, Mo.; Nathan Rodriguez, medical student, Kansas City University of Medicine and Biosciences, Joplin, Mo.; and Janis Coffin, DO, FAAFP, PCMH CCE, FACMPE, MGMA member, chief transformation officer, Augusta University Health, Augusta, Ga.

    The cost of healthcare in the United States continues to increase and is projected to account for almost 20% of GDP by 2020.

    Patients have endured the steady increase in costs for insurance policies, deductibles and copays, which has further exacerbated the perpetual cycle of non-adherence of medicinal regimes.

    Providing physicians with tools to help them consider brand-name or generic drug alternatives is a way to engage patients in the management of their care and potentially help with medication regime compliance.

    Patients unable to adhere to a course of treatment impedes the goal of fulfilling the objectives of the Institute of Healthcare Improvement’s Triple Aim initiative:

    • Improving patient experience of care
    • Improving the health of populations
    • Reducing the per-capita cost of healthcare

    For healthcare providers to meet these established objectives, it is imperative for them to know and understand the measurements in which the objectives are built upon. In the case of prescription medication, rising costs are impeding fulfillment of the objectives set by Triple Aim, but tools are available to aid in making prescription medication attainable for patients, helping to meet the objectives set by Triple Aim.

    Physicians have a great responsibility in caring for their patients and ensuring that their patients have the means to adhere to their course of treatment. This includes making sure the patient is taking medication prescribed to them at the doses and times recommended by their healthcare provider.

    The increasing cost of prescription drugs is becoming a growing concern for all involved in providing healthcare. Between 20% and 30% of prescription medications are not filled, and 50% of those that are filled are taken in a way that does not meet the definition of adherence. The primary reason for scripts not being filled is cost, which is due to the high price of branded products protected by patents. Between 2008 and 2015, prices for most commonly used brand-name drugs has increased 164%,1 while the average increase in salary was only 2.68%. The cost of prescription medication often exceeds the financial means of the average patient.

    While increases in prices are mostly limited to brand-name drugs that treat rare diseases, there have been increases in the costs of drugs that treat millions of people every year such as insulin, isoproterenol, nitroprusside and digoxin.2 For instance, the price of insulin — used by more than a million Americans — has increased by 197%.

    Due to these price increases, it’s more important than ever to inform physicians and patients about tools to obtain cost-effective prescription medication. Without the use of these tools, patients are less likely to be able to afford their medication and are likely to end up in urgent cares and emergency rooms with issues that could have been managed with an affordable treatment regime. Adherence to medication regimens would help lower overall healthcare costs and significantly improve healthcare outcomes.

    Prescriptions and the Triple Aim

    The first objective of the Triple Aim is patient experience, gauged by survey responses. These surveys are looking for but are not limited to patients’ willingness to recommend their healthcare provider, which is determined by patients’ response to a key set of dimensions:

    • Safety
    • Effectiveness
    • Timeliness
    • Efficiency
    • Equitability
    • Patient centered

    The second objective is improving population health, assessed by looking at the health/functional status, risk status, disease burden and mortality of the given population. One of the instruments used to analyze the health and functional status of a given population is EuroQol, which accounts for a person’s mobility, self-care, usual activities, pain-discomfort and anxiety and depression. Lastly, the per-capita cost is measured by looking at the total cost per member of the population per month and the hospital and emergency department utilization rate. The total cost is broken down into how much a patient costs per month and how often a patient visits the hospital and emergency department. Each of these objectives can be affected by patients not being able to afford their prescriptions.

    When patients cannot afford their medication, their health may decline, making it difficult to improve the overall health of certain populations, have a great patient experience and lower the per-capita cost. These situations can be alleviated by having a patient-centered approach that not only focuses on patients’ preferences, needs and values, but also patients’ socioeconomic status.

    Prescription assistance

    An effective way to tackle the high costs of prescription medication is to use resources such as Triple Aim, which can not only reduce costs but improve the health of populations by allowing them to hold fast to their prescription medication.

    • RXAssist (rxassist.org) is a patient assistance program operated by pharmaceutical companies. The program allows physicians and patients to search for medications that may be offered at a reduced price, with eligibility information and applications available through an app.
    • GoodRX (goodrx.com) can be accessed online or through an app. It allows physicians and patients to search for the cheapest prescription medication provided by companies such as CVS, Target and other retail pharmacies. The app collects and compares prices from more than 60,000 U.S. pharmacies and offers coupons for prescription medication. Additionally, the app offers the option of choosing between brand and generic, medication form, dosage and the number of tablets per script.
    • LowestMed (http://www.lowestmed.com) allows physicians and patients to search for prescription medication at the lowest cost, with the option to search based on ZIP code. Similar to GoodRx, LowestMed allows the physician or patient to change the drug details depending on dosage and amount to better tailor their search. Once the search is complete, coupons can be accessed and presented to the pharmacy upon pickup.
    • NeedyMeds (needymeds.org) was designed to help individuals find assistance programs so they can afford their medication. In addition to searching pharmacies by ZIP code, NeedyMeds also offers a search of the $4 generic drug program offered by many pharmacies, such as Walmart, Target and CVS. The complete list of pharmacies offering the $4 generic drug option and the medication available can easily be accessed.

    Having accessible tools will allow for more affordable prescription medications and more patients will be able to follow their medication regimen. Getting patients to adhere to their medication will lead to fewer clinic and emergency department visits.

    By adhering to the Triple Aim’s objectives, healthcare providers will be able to provide a better patient experience. 

    Notes:

    1. Kesselheim AS, Avorn J & Sarpatwari A. “The high cost of prescription drugs in the United States.” Journal American Medical Association, 2016, 316(8), 858-871. doi:10.1001/jama.2016.11237
    2. Ibid.

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