Question

What is the biggest issue you see that is contributing to drug prices and why?

Answer 1

Providers bear the cost when consumers don't fill their prescriptions because of the increased risk of these patients coming to the ER or of being readmitted to the hospital when their conditions worsen.

Nearly 30 percent of Americans don't take their prescribed medications because of high drug prices, according to the Kaiser Family Foundation health tracking poll released in February.

This affects numerous Americans, as six in ten use prescription drugs. Among senior citizens, nine in 10 use prescription drugs and more than half take four or more.

The data on prescription adherence is available to pharmacies and insurers through claims and is increasingly of interest to providers who are tracking how the social determinants, such as income, play a role in health and value-based care.

Lack of medication adherence costs the U.S. health system as much as $528 billion in the context of possible consequences, illnesses, and deaths that result from non-adherence, according to the survey by OptimizeRx, which is in the business of offering a cloud-based solution in support of patient adherence to medications. The digital health company connects pharmaceutical companies to patients and providers.

Drugs are a heavy burden on hospitals

Prescription drugs are the number one utilized health insurance benefit by plan members, outpacing their doctor visits.

The price of drugs is seen as the reason why healthcare costs can't be brought in-line.

Hospitals bear a heavy financial burden when the cost to buy drugs increases. Not only in the purchase price, but in patients ending up in the hospital when they cannot afford their medications.

Providers dealing with higher costs must make cuts elsewhere, according to a study released by the American Hospital Association and others. Twenty-five percent of those responding to the study said they had cut staff and 17 percent said they had cut services.

Health plans have become increasingly intertwined with their PBMs to better compete, realize cost savings and to produce efficiencies.

The largest, UnitedHealthcare, is connected to OptumRx through parent company UnitedHealth Group; Cigna closed on its $67 billion purchase of Express Scripts in December; CVS Health and Aetna also merged late last year in a $69 billion deal; and Anthem is ready for an early launch of of its in-house pharmacy benefit manager, IngenioRx.

TREND

The vast majority of patients raise the issue of prescription prices with their doctors and 86 percent of physicians are comfortable discussing these and other healthcare costs, according to the survey.

Other factors physicians cited for unfilled prescriptions include intolerable or unpleasant side effects (45 percent); a patient's desire not to take pills (34 percent) and patients already taking too many pills (31 percent).

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