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Subscriber Exclusive: When Price is a Concern

Provide options for those in whom costs could be an obstacle to glaucoma treatment

When prescribing a medication, you will find that some patients express concerns about affordability, however most will not, even if they are thinking it. In fact, a survey of consumers by Truven Health Analytics-NPR Health, found that 97% of respondents who received a prescription in the last 90 days filled it. However, the most cited reason for those who did not, at 67%, was cost.

Cost is not an easy conversation for most people to have, especially one-on-one between a patient and his provider; so when it comes up, it’s best to have a plan. This article will discuss how to establish practices for addressing patient concerns over costs of glaucoma medications, while still offering the best medicine for the patient.

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Above all, as providers, we need to cultivate relationships with our patients that will permit them to confide in us all their concerns about medications, including affordability. That said, step one should be to educate the patient. If we feel strongly that a specific medication is the best option for the patient, a discussion of the benefits and why we feel this way may help the patient to purchase and use the medication as prescribed.

I find this to be a very easy, natural part of the discussion I have with patients when I am describing to them the what, followed by the diagnosis, and then the natural course would be how and why I feel it will be best treated/managed. It is then you need to use your judgment as to whether to discuss cost with the patient. I tend to say something like “How well does your health insurance cover your prescriptions?” Common responses include: “It’s really good,” or “It’s largely out-of-pocket.” In the case of the latter, I will discuss with them assistance/discount plans that will aid in defering the cost of the medication. I tend not to let cost dictate how I treat disease. I feel that begins to call into question standard of care.

That said, I feel we should always make an effort able to provide something to help the situation, be it a sample, a smaller bottle, a discount card, a website that offers price comparisons or discounts or an assistance program. Also, if a generic drug is available that has been proven to be as efficacious, I will be inclined to prescribe that. There are a host of programs available to us as providers — and to patients — that, with a little research and maybe some phone calls, should allow most patients access to the appropriate medications.

Assistance Programs

How can we help our patients to do what’s best for their eye health and their budgets? Resources are available from pharmaceutical companies and nonprofit programs. A caveat: Use caution whenever sensitive patient health and financial information is relayed via the internet. Do your diligence in researching the background of a foundation before offering it as a solution to your patients. Most pharmaceutical companies partner with reputable prior authorization sites as well, so ask your reps who their companies recommend. It’s in their best interest to help you get their medications into your patient’s hands, and, as such, they are a great resource.

Manufacturer assistance. A variety of glaucoma medication cost assistance programs are available to patients, with some requiring financial information disclosed for qualification. Programs provided directly by the pharmaceutical companies:
  • Aerie Pharmaceuticals: rhopressa.com/save-on-rhopressa
  • Alcon: patientassistance.com
  • Bausch + Lomb: bauschhealth.com
  • Allergan: savewithays.com
  • Merck: merckhelps.com
  • Pfizer: pfizerrxpathways.com
Foundation assistance. There are foundations that offer patient assistance and, again, some do require financial eligibility requirements to be met. Examples include:
  • Eye Care America: (aao.org/eyecare-america) This offers free glaucoma eye exams and initial treatment.
  • RxHope: (rxhope.com) This supports low-income residents with free or low-cost prescriptions.
  • NeedyMeds: (needymeds.org) This is a tool to direct patients to coupons, discount cards and assistance programs.
  • RxAssist: (rxassist.org) This is similar to NeedyMeds, as it directs patients to programs and coupons.      
Comparison tool. A number of websites provide drug price comparison tools for patients. (Some also offer these tools through a mobile app.) These websites provide their services at no cost to the patient and usually do not require a fee or financial qualifications to be met.

An example of how these sites work is for the patient to enter his zip code and the drug name. Often, the patient can refine the search by entering information, such as strength, dosage and quantity of the drug. The website will then provide a list of local pharmacies, drug prices and discount/coupon information. Examples of these websites include familywise.org, goodrx.com, pharmacychecker.com, rxsaver.retailmenot.com, saveonmymeds.org, webmd.com/rx and wellrx.com. However, note to patients that this is in place of an insurance benefit, not in addition to, so it is, therefore, beneficial to compare which benefit will work most in their favor.

Think Outside the Box

I have also found that cultivating close-working relationships with a few surrounding pharmacies and their pharmacists can prove very helpful when seeking to help patients obtain medications at the lowest cost. Pharmacies will often price match and search for prices or electronic discount coupons to be able to provide substantial savings to the patient. This does require a bit of work from the pharmacy technician sometimes, so having those relationships in place beforehand can often times be very valuable to your patients.

Bottom Line

By addressing the patient’s cost concerns, we improve medication compliance while offering the best medicine.  OM