How a Macon patient saved $6,500 on prescriptions this year

A few months ago, nurse practitioner Michelle Rowell noticed prices popping up on her computer screen when choosing which medication to prescribe her patients at the Bariatric and Metabolic Institute, Navicent Health.

In the past, she’d prescribe her patients at the office, and then wait for a phone once they got to the pharmacy and found out their medication was more than they could afford.

Now, Rowell can compare the prices of different drugs before she writes a prescription. And her patients already have started saving money.

With prescription prices on the rise, innovative solutions are surfacing to save consumers money and help them afford their medications. One new tool has already saved one Bariatric and Metabolic Institute patient $6,500 this year.

A new prescription price transparency tool, developed by the health technology companies Cerner and Surescripts, allows doctors to compare the prices of multiple similar drugs before prescribing their patients. Cerner has launched the program at over 30 health care providers across the country in the past four months, and it’s saved consumers more than $15,000 in Georgia and $480,000 nationwide, according to the company.

“That is a lot of money,” said Dr. Jigar Patel, Cerner’s vice president and chief medical officer. “And when you think about folks that might not have a lot of money, that is a big impact to their bottom line and then also their health.”

Widespread research on the pharmaceutical industry reflects an increase in drug prices in recent years. According to a March 2016 report by the Health Care Cost Institute, prescription drug prices increased 24.9 percent between 2012 and 2016. Some prices rose over 100 percent during the four-year period, the study found.

“Generally speaking, prescription drug prices have gone up,” said John Hargraves, senior researcher at the Health Care Cost Institute. “Overall spending on prescriptions has gone up, and when we look at spending, you know, the two major things that influence how much we spend on prescription drugs is how many are used and how much each prescription costs, the price.”

Health Care Cost Institute studies the health care spending of those who receive insurance through their employer, which Hargraves said accounts for 49 percent of Americans. Among that group, the average person spends $1,030 each year on prescriptions — $158 out of pocket and the rest covered by insurance. In Georgia, the average was $1,140 in 2016 . Those who are uninsured would have to cover that entire cost themselves.

Hargraves said medication prices can come as a surprise. And when people can’t afford their medication, they might choose not to pick up the prescriptions they need.

“One of the important things for maintaining our health is taking necessary medications, be they antibiotics, be they medications that control chronic illness, such as HIV or diabetes,” Hargraves said. “You know, when the price gets too high, that may invite people to not adhere to medication that improves their overall health.”

As prescription prices continue to skyrocket, health care providers and consumers are looking for new ways to save money. Cerner decided to develop a price transparency tool, so consumers can compare prices before picking up their prescriptions, instead of facing sticker shock at the pharmacy.

Patel said that, in the past, he and other physicians had learned in medical school that cost need not factor into the prescription-writing process, and doctors should focus solely on choosing the best treatment option for their patients. But with modern digital technology, he said doctors have more flexibility to compare prices and take cost into account as well.

“That means a lot in communities such as Macon, where you want to make sure their medication costs and their health care costs are not exorbitant and take up a huge percentage of their bring-home pay,” Patel said.

Several of Navicent Health’s affiliated providers started using Cerner’s prescription pricing tool in April, and patients at Macon’s Bariatric and Metabolic Institute and Dublin Internal Medicine have saved over $7,000 since then. Cerner’s technology allows doctors to look through a list of real costs for different comparable drugs based on their patients’ insurance status.

“It gives you options around alternates that may be cheaper, and then you can take that information and have a conversation with your patient about, you know, ‘this med is comparable, this medication is comparable, and we want to give you this for treating whatever the disease process is, and, but we can save you some money,” Patel said.

Other options are available for Georgia residents struggling to afford their prescriptions.

Several private organizations, such as Georgia Drug Card and the Georgia Prescription Assistance Program provide free prescription discount cards that can be used at partner pharmacies, including Walgreens, CVS, Walmart and Rite Aid, as well as local drug stores.

Nonprofit organizations have also set out to improve prescription accessibility. Good Pill, a not-for-profit pharmacy based out of Gwinnett County, ships reduced-price medications to Georgia residents who can’t afford their prescriptions on their own. The pharmacy receives surplus drugs from multiple donors, such as long-term care facilities and nursing homes, as part of Georgia’s Donated Drug Repository Program.

During the 2015-16 state legislative session, lawmakers passed a bill to encourage those with unused drugs to donate them to private health care providers whose patients struggle to pay for their prescriptions. Since its launch at the beginning of the year, Good Pill has already helped about 1,000 patients throughout the state afford their medication, according to Georgia Health News.

But while these new programs can mitigate health care costs for patients, they don’t target the root issue of high prescription prices. Sean Dickson, an officer at The Pew Charitable Trusts’ Drug Spending Research Initiative, said changes in government policy could help to rein in prescription prices.

“The prices of prescription drugs are increasing faster than the rate of inflation and faster than other medical costs are increasing. And so, we think that addressing those costs and drivers of drug spending will help address the affordability of health care overall,” Dickson said. “We also know that a variety of polls show that Americans can’t afford their medication, and it’s important to ensure that your ability to afford medical care does not depend upon your income.”

One policy proposed by the Drug Spending Research Initiative is a state tax on drug price increases greater than the rate of inflation, which Dickson said might discourage pharmaceutical companies from hiking up their prices. Dickson said revenue brought in from the tax would go into a state fund, which could be used to help patients pay for their prescriptions or to insurance companies hoping to offset the cost of premiums.

Researchers at Pew Charitable Trusts have also reached out to several states about a policy that would give Medicaid more room to adjust prescription prices that increase greater than the rate of inflation, as well as increase the penalty for drug manufacturers whose prices rise at an excessive rate.

Dickson said he thinks state policies represent a new opportunity to curb drug spending because states dedicate large portions of their budgets to Medicaid spending and health care benefits for state employees.

“Addressing drug costs is an imperative for states,” Dickson said. “And we’re really looking to work with states to find solutions.”

Samantha Max is a Report for America corps member and reports for The Telegraph with support from the News/CoLab at Arizona State University. Follow her on Facebook at facebook.com/samantha.max.9 and on Twitter @samanthaellimax. Learn more about Report for America at www.reportforamerica.org.

This story was originally published August 10, 2018 at 3:52 PM.