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    Top 10 challenges facing physicians in 2018


    6. Costs as barriers to patient adherence

    Getting patients to adhere to a medication regimen has been a long-standing challenge for doctors. But the ever-rising costs of prescription drugs, combined with the greater share of those costs falling on patients in the forms of deductibles and copays, are making the task even harder. 


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    The reasons for the increases in prescription drug prices, whether brand-name or generic, are a matter of debate. But the impact on patients is not. Studies from a wide variety of governmental, professional and non-profit organizations all point to the conclusion that adherence is closely tied to the cost of drugs, and what patients must pay out-of-pocket to obtain them.  

    “All patients care about the cost [of prescriptions], even patients who are wealthy,” says Damon Raskin, MD, an internist and addiction medicine specialist in Pacific Palisades, California. “Especially older patients who are on multiple medications it’s a big chunk each month depending on what they’re taking.”

    Doctors who have confronted the problem and experts recommend the following:

    Address the issue head-on 

    “If adherence is detected to be a problem for a patient, one of the questions that’s often asked now is, ‘Are you having trouble affording your medications?’” says former practicing internist Eric Schneider, MD, FACP, now with The Commonwealth Fund.

    Prescribe generics whenever possible 

    While prices for generic drugs have also been rising, in most cases they’re still substantially below their brand-name equivalents. So except in cases where a generic is ineffective or contraindicated, they are powerful tools for overcoming financial barriers to adherence.

    Help patients find financial assistance 

    Provide information about the financial assistance programs most major pharmaceutical companies now offer. Patients who meet the income criteria can get free or deeply discounted copays. Nonprofit and government organizations in many communities also provide help to patients who can’t afford needed medications. 

    Turn to technology 

    Make sure patients know about the numerous apps and websites, such as GoodRx and OneRx,that enable comparison shopping for copays and/or provide access to discounts for certain medications. 

    Partner with pharmacists

    As the professionals actually dispensing the medications doctors prescribe, pharmacists can help battle high drug costs. Some large, multi-specialty practices employ their own pharmacists who work directly with patients to find the most cost-effective medications for treating their diseases or conditions. Joe Moose, Pharm D., co-owner of a North Carolina-based chain of independent pharmacies, notes that the typical patient in that state sees a pharmacist 10 times more often than a primary care provider in the course of a year. “That means we have 10 times more opportunities to reinforce the care plan. That’s the real way you save on drug costs,” Moose says. He suggests making pharmacists part of the care team by sharing patient treatment plans with them whenever possible. 

    For more strategies on increasing patient adherence, visit bit.ly/18-adherence

    Next: Rapidly changing reimbursement landscape

    Rose Schneider Krivich
    Rose is the content specialist for Medical Economics.
    Todd Shryock
    Todd Shryock, contributing author


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