Prescription medications, including specialty drugs, now represent more than one out of five healthcare dollars, when looking at the average American benefit plan. That’s more than the costs for inpatient care (19%), and the drug share is rising. The frequently cited figure of 10% of total healthcare costs includes expenses for all care such as long-term care and many other personal care services not covered by employer and individual medical plans.
The good news is that when used as prescribed and sourced well, drugs improve health, quality of life and reduce medical complications, which in turn increases our economic productivity and lowers costs.
However, studies show that half of all patients do not take their medications as prescribed and more than 20% of new prescriptions go unfilled. A top reason is cost. Doctors are not always in a position to know what a medication costs or whether there is a lower cost alternative brand name drug or a generic option available. That often leaves it to the patient to find the right drug at the lowest cost.
Fortunately, there are new tools that are making it possible for consumers to shop for the best value and receive helpful reminders to take and refill their prescriptions on time. They are:
1. Online and mobile tools
The ongoing migration to high-deductible health plans means more consumers will need these tools now and in the future. More than one-third of HealthPartners members (roughly 400,000) have a high deductible health plan and for the past several years it has been the fastest growing product design.
One challenge for consumers is that medication prices can vary significantly by pharmacy, even from pharmacy to pharmacy with the same retailer. Prices are negotiated differently by payer and also change regularly. These are some of the reasons why it’s difficult for patients, and their doctors, to know what they will pay when they get to the pharmacy counter.
Tools like drug cost calculators can help consumers to comparison shop. In addition to price, these tools show consumers how they can save money by ordering through mail order, by ordering a 90-day supply or with generics. However, they can be challenging to use. A new generation of easy-to-navigate web tools, include desktop search features and mobile apps with price comparison data and discounts. These are especially useful for people who do not have prescription insurance or who are in the deductible phase of their health plan and want to lower their out-of-pocket expenses.
HealthPartners is improving price information with a new web application being developed in partnership with GoodRx. When it is launched this summer, it will be available as an app on tablets, smartphones and desktop computers. The tool will provide information such as:
· Real-time prices and out-of-pocket costs, based on their health plan benefits, at any contracted pharmacy in their current geographic area. The costs provided reflect the negotiated prices after discounts. They do not include rebates.
· Whether the medication is on the member’s health plan formulary.
· If a generic or lower cost brand medication is available.
· Their best choice for pharmacies based on their current medication use.
· the ability to easily transfer prescriptions to another pharmacy with a couple of clicks.
Consumers will also see the cost to the health plan. Again, the costs provided are the negotiated price after discounts and do not include rebates. So even if a consumer might have a low copay, with no differential by pharmacy, they can still choose the lowest cost medication or pharmacy. By choosing the lowest cost drug to the health plan, consumers can help lower their health plan costs which in turn can help minimize premium increases.
Members who may fill a prescription when a lower cost was available will receive messages through email or letters to let them know where they can refill their medicine at a lower price.