Several studies have found that as a patient’s out-of-pocket cost share rises, primary adherence—or the patient’s first prescription fill and use as prescribed—drops significantly. According to IQVIA Institute for Human Data Science’s “Report: Medicine Spending and Affordability in the United States” released in August 2020, prescription abandonment rates are less than 5% when the prescription carries no out-of-pocket cost; it rises to 45% when the cost is over $125 and to 60% when the cost is over $500.
Further, a 2019 study found that 1 in 4 Americans can’t afford their medications and 29% reported not taking their medications as prescribed due to cost.
This is especially concerning when a patient’s adherence to therapy is crucial to their treatment outcomes, as it often is for specialty therapies. Pricing can also impact whether the patient opts to pursue their prescriber’s initial drug recommendation—often best for their specific needs—or chooses a less expensive, alternate therapy that may not have the same health impact or meet the patient’s specific needs.
Healthcare industry trends moving to price transparency
Further, the industry is moving to greater price transparency in healthcare coverage. Both drug price transparency and affordability have captured the attention of federal regulators and all stakeholders involved in ensuring patient success with prescribed specialty medications. This is evidenced by the previous U.S. administration’s “Transparency in Coverage” Final Rule, as well as a consensus among life sciences presenters at the 2021 JP Morgan Healthcare Conference to work with the new administration and Congress on affordability issues.
Drug price transparency in real time positively impacts prescription fill rates
With real-time prescription price transparency, healthcare providers can leverage visibility into drug cost at the point of care for specific patients and work with the patient to make informed decisions about prescribed therapies.
Patients empowered with knowledge of their expected financial responsibility at the point of prescription are more likely to fill their prescription and remain adherent to their prescribed medications.
How healthcare providers can access drug price transparency
Healthcare providers can use the Rx Cost and Coverage tool within iAssist to access full drug price transparency for all medications with a national drug code (NDC). iAssist, the most comprehensive therapy initiation tool for healthcare providers, allows users to pull pharmacy benefit pricing and cash options available for primary and secondary prescriptions. Specifically, iAssist users can access:
—Real-time comprehensive patient coverage
—Patient out-of-pocket cost
—Drug access restrictions (e.g., prior authorization required, step edit required)
—Coverage alerts (e.g., age limit, days or supply exceeded)
—Fill options for all therapies including cash options
Start using iAssist today to gain access to drug price transparency, make informed prescribing decisions and help improve your patients’ therapy adherence.