How Can Providers Help Patients Navigate Increased Drug Costs?

Understanding Medication Affordability

To better understand the benefits and uses of Provider Mode and other medication access tools, it is essential to define the problem associated with medication prices in the United States. It is no secret that medication prices have risen dramatically in recent years, leaving many — especially those suffering from chronic conditions — struggling to make ends meet so they can afford their medications.

An Overview of Drug Price Trends

According to an issue brief released by the Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE) on September 30, 2022, between July 2021 and July 2022, 1,216 prescription drugs increased in price.

Additionally, the brief stated, “in January 2022, the average price increase was nearly $150 per drug (10%), and in July 2022, it was $250 (7.8%). July increases tended to be for higher priced drugs than those in January, resulting in higher dollar increases but smaller percentage increases.”

What Contributes to Increased Pricing?

Beyond understanding the trends in medication prices, it is essential for stakeholders to better comprehend the driving factors of these increased costs. According to a chapter of Making Medicines Affordable: A National Imperative, research and development, launch prices, and market competition contribute to drug pricing.

According to the textbook, wide variations in research and development costs may impact the pricing of these medications when they come to market. The publication states that the allocated spending for research and development has increased over recent years. One may assume that increased costs contribute to this research and development.

Despite these claims, a recent study published in JAMA Network Open found that research and development do not justify medication costs. The study analyzed 60 acute, chronic, and cyclical medications but found a lack of association between research and development and drug pricing.

An additional contributing factor to increased drug costs is elevated launch prices. Authors in Making Medicines Affordable: A National Imperative write, “The cost of branded drugs is influenced by their launch prices — the prices set by the manufacturer for the new drugs when they first become available on the market — and the subsequent annual increases in their list prices. Recent data on anti-cancer drugs show that on average launch prices increased by about $8,500 per year over the past 15 years. Other studies have found similar increases in the prices of cancer drugs after their launch.

Another factor that alters medication costs is market competition. Logically, increased market competition can drive down drug costs. Having multiple companies that produce similar medications puts them in competition with one another to be the best medication choice. However, pharmaceutical patents and the abuse of the patent system have led to extended market exclusivity for many companies, preventing competition and allowing these companies to monopolize on patients’ need for medication.

The Impacts of Increased Medication Costs

Drug costs have presented a significant barrier to managing chronic conditions. “The key to chronic disease management is consistency — in communicating with providers, in making lifestyle changes, and in taking medications that treat symptoms and halt the progression of the disease. If prescriptions are prohibitively expensive, patients are much less likely to adhere to their medication regimens. Conversely, when medications are both affordable and easily accessible at a pharmacy near them, patients are much more likely to take medicines as prescribed, achieving consistency in this critical part of their treatment plans,” stated Parikh.

Provider Mode

PharmaNewsIntelligence asked Parikh what Provider Mode is and how HCPs can utilize it to deliver better patient care and connect patients to more affordable medications.

According to Parikh, “Provider Mode is a new experience built for healthcare providers that helps them find affordable solutions for the medications they prescribe. It offers a redesigned prescription savings flow and a faster, more customized experience to help providers and office staff find the information they need, so they can spend more time focusing on patient care.”

She shared that the development of this platform included input from internal and external provider focus groups in determining how best to integrate the tool into the provider’s workflow.

The idea behind this tool is to allow providers to compare drug costs in one platform easily. “Before Provider Mode aggregated all the prescription cost information that HCPs needed in an easily accessible place, providers were either using GoodRx, but needing to toggle between windows, or they had to get a bit creative and pull information from disparate sources,” noted Parikh.

“Patients often had to go to their pharmacies to check the prescription’s price and let their provider know if it was too expensive. Then the provider would switch out the script for another similar medication at a lower price point,” she highlighted. “Other HCPs fortunate enough to be supported by office staff would also research drug manufacturer discounts. Still, of course, they would have to visit individual pharmaceutical company websites one by one, which was cumbersome. In short, none of the methods being employed were truly efficient.”

Features of the Tool

Throughout the conversation, PharmaNewsIntelligence asked Parikh to highlight critical tools that would be of significant use to providers.

“As part of the new experience, providers can easily compare medication prices across drug classes, pharmacies, and zip codes. They can quickly find and replicate their frequent searches and most prescribed medications, send coupons directly to patients without sharing their contact info, find personalized, relevant industry news and answers to common health questions, and discover information on available brand drug savings programs,” she responded.

Impacts of the Tool

The clear benefit of this tool is to increase access to affordable medications. Parikh expanded on the potential benefits for patients and providers.

“Affordability is a massive barrier for patients looking to access quality care. According to a GoodRx survey, about 1 in 3 people who take prescription drugs for a chronic condition reported skipping at least one prescription fill due to cost,” she began. “To increase the chances that patients will adhere to their treatment plans, Provider Mode helps providers find more accessible prescription options. With the Cost Compare feature, providers can compare the prices of similar medications to choose a cost-effective medication that patients, regardless of insurance status, can afford and stay on for as long as they need. Providers can also learn more about savings programs for brand drugs directly through Provider Mode. The goal is to increase provider awareness for the most affordable medications to increase patient access to those drugs.”

Additionally, Parikh notes that this tool will streamline provider workflow by limiting the need to scour multiple websites or physically go to pharmacies for information on medication costs.

“In addition to the cost-saving benefits of Provider Mode, we’re excited about the time-saving benefits. The American Medical Association estimates that providers spend about 15 hours a week trying to provide access to medications for their patients. Provider Mode was built with this challenge in mind. By streamlining the prescribing process, this experience will help providers spend less time on administrative tasks so they can focus on patient care, including better understanding patients’ financial constraints and finding the best possible treatment plans to fit their needs,” concluded Parikh.

Looking Ahead

Moving forward, physicians and other healthcare professionals may more heavily utilize tools such as this to provide equitable medication access. Despite the projected benefits of this tool, it is newly launched, and additional analysis of its outcomes may be necessary before being able to say that it has widened medication access definitively.