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Clinical Practice Corner

Addressing the High Cost of Prescriptions

Addressing-the-High-Cost-of-PrescriptionsA recent study in the Journal of the American Medical Association brought stark attention to the fact that per capita spending on prescription medications is higher in the United States than in any other country in the world. Numerous other studies have revealed that patients with cancer are among the most vulnerable when it comes to the cost of their treatment, particularly the cost of lifesaving medications.

“The drug prices are higher and the treatments are longer for patients with cancer,” says Yousuf Zafar, MD, associate professor of medicine and public policy at the Duke Cancer Institute.

Drug costs are one component of the larger overall challenges of health care costs that Zafar calls “financial toxicity.” But, the high—and growing—cost of prescription medication is contributing to a disturbing trend of cancer patients delaying or skipping their treatments because they believe they can’t afford it. Zafar was lead author on a study published in The Oncologist showing that 25% of patients with cancer chose to not fill a prescription because of cost, and 20% filled only part of it or took less than what was prescribed.

For elderly patients with cancer, the cost of prescription medications is an even bigger challenge. A recent JAMA Oncology study showed that Medicare patients with cancer spend an average of 11% of their income on treatment.

“Cancer patients are sensitive to the costs of treatment, even if it is lifesaving,” Zafar says.

For doctors caring for patients with cancer—or even patients with other chronic health diagnoses—this means helping to identify opportunities to minimize prescription costs, particularly for patients who have the greatest risk of experiencing financial toxicity.

Zafar recommends that doctors act early and often and consider the following strategies:

Patient Assistance Programs

Physicians can help their patients who are concerned about the cost of their prescription drugs by guiding them through patient assistance programs, or PAPs. Patients may be eligible for these programs run by drug companies, state governments, or nonprofit groups:

Partnership for Prescription Assistance offers programs sponsored by a consortium of drug companies, doctors, and advocacy and civic organizations that help low-income, uninsured patients get free or low-cost, brand-name medications.

NeedyMeds maintains an extensive database of PAPs, state assistance programs, drug discount programs, and free or low-cost medical care. The organization also has information about thousands of programs to help patients through the application process.

Center for Benefits is a program of the National Council on Aging that shares information about assistance programs for low-income seniors and young people with disabilities.

RxAssist houses an online database of drug company programs that offer free or affordable drugs and copay assistance.

RxHope provides an online resource to search by medication to locate assistance programs. The resources also offers help with the application process.

RxOutreach is a mail-order pharmacy for patients with little or no health insurance coverage.

Educate. Once patients have a diagnosis, it’s important that doctors prepare and inform them about the costs of treatment. And beyond the cost of medication, there are other expenses such as the cost of provider and clinic visits, lab and imaging tests, surgery and radiation treatments, hospital stays, and home care.

Screen. Clinicians should be direct about asking their patients whether they can afford treatment, and this should be part of a screening mechanism to determine whether there will be a financial burden. Once identified, providers may be able to make changes to treatment plans that consider a patient’s economic position.

Connect. If it’s clear that affordability will be a factor, providers can work with insurers on behalf of their patients or link them to financial counselors or prescription assistance programs (PAPs) that can help alleviate the economic burden of treatment. Although the application process for PAPs can be convoluted, it’s important that patients know about such resources.

Ultimately, what this all comes down to is what doctors care most about: the well-being of their patients. Not addressing the financial distress related to treatment for cancer patients may translate into a higher risk of mortality.

“This needs to be an ongoing conversation between oncologists and their patients,” Zafar says. And, in a Journal of the National Cancer Institute commentary, he advises oncologists to focus on the value of care delivered, encourage patient engagement on the topic of costs, and be tuned in to the financial resources available to patients.

“With a growing list of financial side effects induced by cancer treatment, the time has come to intervene on the financial toxicity of cancer care,” he says.


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