Manage

Medication Cost

search

Medication Cost, Pharmaceutical Representative, Drug Rep, Prescribing Cost, Sunshine Act, Drug Cost

  • Management
  • Lowering Patient Drug Costs
  1. Identify Generic Drug equivalent alternatives to expensive drugs
    1. Choose preferred medications from patient's insurance formulary
    2. If coupons and discounts expire for a pricey medication, consider less expensive alternatives
      1. Avoid prescribing longterm drugs with only shortterm coupons
    3. Consider drug assistance programs
      1. Consider for very expensive drugs (e.g. cancer Chemotherapy, monoclonal antibodies)
      2. See Medication Cost Assistance Program
  2. Consider Deprescribing medications with low efficacy or that are no longer indicated
    1. See Polypharmacy
  3. Evaluate Medication Adherence in chronic disease
    1. Noncompliance may be responsible for uncontrolled disease
    2. Adding another pricey medication may do little to improve disease control
  4. Prescribe 90 day supply
    1. May decrease prive and improve Medication Adherence
  5. Health savings account (HSA)
    1. Patients who have HSAs may use these to purchase medications with pre-tax dollars
  6. References
    1. (2024) Presc Lett 31(4): 22-3
  • Research
  • Studies
  1. Evaluation of 446 physicians surveyed
    1. Higher Prescribing Cost risks
      1. Pharmaceutical Representative exposure
      2. Group practice setting
    2. References
      1. Caudill (1996) Arch Fam Med 5:201-6 [PubMed]
  2. Direct drug advertising to healthcare consumers
    1. Appears to increase sale of drugs
    2. May result in inappropriate prescribing practices
    3. In 2017, Lyrica marketing cost $216 Million <5% of its over $5 Billion revenue for the year
    4. Mintzes (2002) BMJ 324:278-9 [PubMed]
  3. Pharmaceutical samples raise overall Prescribing Costs
    1. Symm (2006) J Am Board Fam Med 19(5): 443-9 [PubMed]
  4. Poorest patients are the least likely to receive free drug samples
    1. Typical drug sample recipient has health insurance and lives far above poverty line
    2. Cutrona (2008) Am J Public Health 98(2): 284-9 [PubMed]
  5. In 2004, >25% ($16 billion) of drug company advertising ($57 billion) was spent on samples
    1. Gagnon (2008) PLoS Med 5(1): e1 [PubMed]
  • Background
  • Legislation
  1. Sunshine Act (U.S. regulation as of August 2013)
    1. Pharmaceutical Representative gifts over $10 are reported to a public list (with the provider's name)
  2. Prescription cost transparency (2019)
    1. New U.S. legislation in 2019 requires drug advertisements to include the wholesale cost of the drug
  • Resources
  1. No Free Lunch
    1. http://nofreelunch.org
  • References
  1. Dachs (2009) Am Fam Physician 79(10): 891-4 [PubMed]