Amid rising medication costs and shifting insurance policies, patients and clinicians are increasingly engaging in crucial discussions about drug affordability. Recent studies and reports highlight the evolving landscape of healthcare costs, emphasizing the need for transparent communication between healthcare providers and patients. Following training sessions, which included a 60-minute presentation and group discussions, the number of patients speaking with clinicians about medication costs surged from 17% to 32%. This trend underscores the importance of addressing financial barriers to accessing prescribed treatments.
A December federal report revealed a significant shift in employer-sponsored health insurance plans, moving from fixed copayments to requiring employees to pay a percentage of drug costs. This change has contributed to the "sticker shock" many patients experience at pharmacies. In fact, polling data from the nonprofit KFF found that nearly three in ten adults reported not taking their prescribed medications in the past year due to financial constraints. Such findings highlight the urgent need for healthcare providers to initiate conversations about medication affordability.
One study demonstrated that even a single 60-minute training session significantly impacted patients' willingness to discuss medication costs with their healthcare providers. These training sessions typically involve a 20-30 minute slide presentation followed by a group discussion, creating an environment conducive to open dialogue.
Clinicians often face the challenge of learning too late that patients have been unable to purchase or adhere to their prescribed medications due to cost. This delay can be detrimental to patient health outcomes and emphasizes the need for proactive conversations. According to Kevin Fiscella, MD, MPH, understanding the exact medications a patient is taking can be challenging due to variability in generic drug appearances.
“Most of us have no idea what color looks like because if we’re prescribing generics, they could be any color,” – Kevin Fiscella, MD, MPH
Encouraging patients to bring their medications in a bag during appointments can provide clarity.
“So, if they bring in their bag, you can see what they’re on.” – Kevin Fiscella, MD, MPH
Moreover, many patients bear the full cost of medications until they meet their insurance deductible.
“They may be bearing the full cost of the medication until they hit the deductible,” – Kevin Fiscella, MD, MPH
This financial burden is particularly challenging given that patients often take numerous drugs, sometimes up to 20 different medications. The introduction of Medicare Part D protections aims to alleviate some of these financial pressures. These protections apply to approximately 56 million people enrolled in these drug plans but do not extend to the general commercial plans serving around 200 million US patients. A significant provision of the Inflation Reduction Act of 2022 establishes a $2000 limit on out-of-pocket spending for drugs purchased through Part D.
Additionally, Medicare is negotiating discounts on certain drugs, with the first set expected to begin in 2026. This initiative allows Medicare recipients to spread out costs for expensive medicines without altering the total amount paid. These changes are critical as deductibles and copays reset annually, prompting more patients to voice concerns about medication costs.
In practice, integrating questions about a patient's ability to afford medications into the already busy schedules of medical staff is crucial. A 2019 article for the American Academy of Family Physicians journal, FPM, offered practical suggestions for achieving this integration. Clinicians can also utilize resources like the JAMA Patient Page to empower patients and families struggling with medication costs.
“You can empower patients and families by printing the JAMA Patient Page and sharing it with anyone struggling to afford their medicines,” – Lalani
“This is a great educational resource and will help them to get started.” – Lalani
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