The Consumer Report’s Article “How To Pay Less For Your Meds” is a MUST READ: Here’s Why and Some Advice
Posted by: Gerald “Pharmacist Jerry” Finken, RPh, MS
Photo: Dan Saelinger/Trunk Archive, accessed from the Consumer Reports Article published on line on Apri 5, 2018.
The feature article written by Lisa Gill and published on April 5th 2018 by Consumer Reportstitled “How to Pay Less for Your Meds” is one of the best patient-focused articles on drug prices written in the past year. I highly recommend that all healthcare professionals and patients read it. Here are three reasons why:
- The article helps patients to better understand how medications are priced and urges healthcare providers to put educating patients about their health, their medications, and their costs at the top of their lists. She identifies both doctors and pharmacists as the ones to be responsible for this education and central to a strong healthcare triad with the patient. Gill includes the input of the pharmacist, who is the “meds expert”, the healthcare professional with the most accessibility and interactions with the patient, and someone that most patients trust.
- The article clearly demonstrates the illogical methods used by the insurance industry in determining drug coverage and costs. Gill introduces us to Mr. Chuck Vanderwist, who was forced to make a very difficult choice – to buy or not to buy his much needed medication in the wake of his insurance company deciding to “no longer cover his prescription for Humalog”. Mr. Vanderwist couldn’t afford the drug on his own. The cycle of decline began and quickly led to a series of pricey events for the insurance company, which cost significantly more than that of the drug they refused to cover. Vanderwist stated, he was forced to ration his dosing which landed him in the emergency room several times. The average cost of an emergency room visit is $1,233.00. Let’s do the math. The insurance company paid $2,466 for the emergency room visits so that they didn’t have to pay the $274 per vial for Mr. Vanderwist’s Humalog. This is illogical, even if Mr. Vanderwist was using two vials per month (estimated $550) and assumes he paid cash and did not use any coupons, which are readily available.
- The article clearly outlines the absolute lack of clarity on how medications are priced and what the real costs are. For instance, the chart titled “Which Pharmacies Have the Best Rx Price?” lists a wide range of prices for five commonly prescribed generic drugs. What I found interesting is that the pharmacies (Walgreens, Rite Aid and CVS/Target) able to gain the best pricing from the manufacturer were the most expensive, whereas the independent pharmacies, which have the least amount of buying power, were among the least expensive. This squarely puts the exaggerated cost of drugs on the shoulders of the “big box pharmacies” and others whose focus is profit rather than the health of the patient. What is really needed here is pricing transparency. The public should have the right to know exactly what the pharmaceutical company is charging in terms of “net-price” for a drug, in addition to the final price they are paying. What does the final price include? Itemized: the “net-price” plus the rebate and coupon costs, wholesaler costs and profits, pharmacy costs and profits, as well as other, non-value add costs—for improving a patient’s health-and profits of middlemen like PBMs and the insurance industry.
My Advice: Best to Direct Drug Questions to the Pharmacist and Make Sure You Get Your Money’s Worth
I have all the respect for Ms. Gill, her professionalism and the thorough reporting conveyed in her article. That said, I have two thoughts, from a pharmacist’s perspective, that could enhance this discussion.
The first: I would advise patients to use the limited time they have with their doctor during visits to ask the most important questions, like “What is wrong with me?” and “What can I do about it?” and to leave the discussion regarding drug relevance, cost and benefits of long term prescriptions to later on with their pharmacist, who after all is the drug expert in the triad.
Moreover, patients confide in their pharmacists. All too often as a pharmacist, I have heard patients say things like, “I would never tell my doctor that” or “I told my doctor I was compliant, but in truth, I was not”. Most of all, it is the pharmacist who would know best if the right drug is being used, the right quantity being dispensed and what the costs will be. As a healthcare provider, I must also point out that even though a 90-day supply may cost less, many meds are not taken for 90 days. So, it may be more cost effective to get only a few days-worth of medications. A perfect example of this suggestion is with opioids where most patients only need a few days-worth of medication, yet doctors write for a 90-day supply. This is one of the reasons why we now have an opioid epidemic (see Pharmacists are the Answer to the Opioid Problem).
The second suggestion I would like to make is for every patient to get their money’s worth. Drugs are expensive, and prices continue to climb, yet most patients never take advantage of getting the full value of the prescriptions they are paying for.
The Omnibus Budget Reconciliation Act of 1990, better known as OBRA-90, required state Medicaid provider pharmacists to counsel Medicaid patients on their prescriptions. This includes a review of the patient’s entire medication profile and a discussion to be had with the patient regarding their findings, especially potential problems like drug-drug interactions, possible side effects and duplication of medications. This counselling service has since been expanded to include ALL patients.
To get the full value of a prescription, whether it is a new prescription or a refill, every patient should insist on talking with their pharmacist—or even demand it. Yet, all too frequently, I see patients sign the standard form stating they do not want to be counseled. If you are paying for this service, why not take advantage of receiving it. This includes mail-order pharmacy. The pharmacist is the medication expert, why not learn what you need to know about your medication and your health. This includes asking:
- Is the drug needed at all?
- What the price of the drug?
- Are cheaper versions or substitutions? This gets around the “gag” orders imposed on pharmacists by many of the insurance providers.
- Is a 90-day supply the best way to go?
The real value and costs savings a patient gains by talking with the pharmacist is that the pharmacist most likely knows about all of the patient’s prescriptions, as well as the over-the-counter medications the patient is taking. Besides knowing about a patient’s medication, the pharmacist, especially in the community setting, also knows and understands the patient’s socioeconomic status and the effect it is having on their health and on their lives. Combining the pharmacist’s counseling and understanding with the dispensing of the drug maximizes the value of the price paid, and in almost all cases, will lead to lower overall healthcare costs and better health outcomes for the patient.
What do you think?