When prescribing a medication, we will find that some patients express concerns about affordability, however most will not, even if they are thinking it. In fact, a KFF Health Tracking Poll, from February, reported that one-fourth of adults say it’s “difficult” to afford their prescription drugs, while three in 10 adults report not taking medicines as prescribed at some point during the past year because of the cost.

Cost is not an easy conversation for most people to have, especially one-on-one between a patient and his provider; so when it comes up, it’s best to have a plan. This article will discuss how to establish practices for addressing patient concerns over costs of medications, while still offering what we feel is the best medicine for the patient.

MAKE TIME FOR THE CONVERSATION

Above all, as providers, we need to cultivate relationships with our patients that will permit them to confide in us all their concerns about medications, including affordability. That said, step one should be to educate the patient. If we feel strongly that a specific medication is the best option for the patient, a discussion of the benefits and why we feel this way may help the patient to purchase and use the medication as prescribed.

I find this to be a very easy, natural part of the discussion I have with patients when I am describing to them the what, followed by the diagnosis, and then the natural course would be how and why I feel it will be best treated/managed with what I’ve prescribed. It is then we need to use our judgement as to whether to discuss cost with the patient. I tend to say something like, “How well does your health insurance cover your prescriptions?” Common responses include: “It’s really good,” or “It’s largely out-of-pocket.” In the case of the latter, I will discuss with the patient assistance/discount plans that will aid in deferring the cost of the medication. (I tend not to let cost dictate how I treat disease. I feel that begins to call in to question standard of care.)

That said, I feel we should always make an effort to provide something to help the situation, be it a sample, a smaller bottle, a discount card, a website that offers price comparisons or discounts or an assistance program. Also, if a generic drug is available that has been proven to be as efficacious, I will be inclined to prescribe that. Another option, when appropriate, is to consider a drug manufactured by a compounding pharmacy, which may provide significant savings. (Information on compounding pharmacy designations 503A and 503B can be found at bit.ly/2K7gxmd .)

There are a host of programs available to us as providers — and to patients — that, with a little research, and maybe some phone calls, should allow most patients access to the appropriate medications.

BE AWARE OF ASSISTANCE PROGRAMS

How can we help our patients to do what’s best for their eye health and their budgets? Resources are available from pharmaceutical companies and nonprofit programs. A caveat: We should use caution whenever sensitive patient health and financial information is relayed via the internet. Also, we should do our due diligence in researching the background of a foundation before offering it as a solution to our patients. Most pharmaceutical companies partner with reputable prior authorization sites as well, so we should ask our reps who their companies recommend. It’s in the rep’s best interest to help us get their medications into our patients’ hands. This makes these reps a great resource.

Manufacturer assistance. A variety of glaucoma medication cost assistance programs are available to patients, with some requiring financial information disclosed for qualification. Programs provided directly by the pharmaceutical companies:

• Aerie Pharmaceuticals: rhopressa.com/save-on-rhopressa
• Bausch + Lomb: bauschhealth.com
• Allergan: savewithays.com
• Merck: merckhelps.com
• Novartis: https://www.pharma.us.novartis.com/our-products/patient-assistance
• Pfizer: pfizerrxpathways.com

Foundation assistance. Foundations offer patient assistance and, again, some do require financial eligibility requirements to be met. Examples include:

• Eye Care America: (aao.org/eyecare-america ) This offers free glaucoma eye exams and initial treatment.
• NeedyMeds: (needymeds.org ) This is a tool to direct patients to coupons, discount cards and assistance programs.
• Patient Assistance: (patientassistance.com ) This is a depository of patient assistance programs.
• RxAssist: (rxassist.org ) This is similar to NeedyMeds, as it directs patients to programs and coupons.
• RxHope: (rxhope.com ) This supports low-income residents with free or low-cost prescriptions.

Comparison tool. A number of websites provide drug price comparison tools. (Some also offer a mobile app.) These websites provide their services at no cost to the patient, and they usually do not require a fee or financial qualifications. Examples include goodrx.com , pharmacychecker.com , https://rxsaver.retailmenot.com and wellrx.com .

An example of how these sites work: the patient enters his zip code and the drug name. Often, the search can be refined by entering information such as strength, dosage and quantity. The website then provides a list of local pharmacies, prices and discount/coupon information. However, we should educate patients that these sites are in place of their insurance benefit, so it is beneficial to compare which benefit will work most in their favor.

THINK OUTSIDE THE BOX

Cultivating close-working relationships with surrounding pharmacies can also prove benefit when seeking to help patients obtain their medications at the lowest cost: Pharmacies will often price match and search for electronic discount coupons to provide savings to the patient. This can require a bit of staff work, but it can be valuable to patients.

By addressing the patient’s cost concerns, we improve medication compliance while offering the best medicine. OM

See “Bolster Compliance With Communication,” https://bit.ly/2Rfe2jx, for additional tips on patient compliance.

DR. HOLT operates West Point Eye Center in West Point, Utah, where he specializes in contact lenses with particular interest in keratoconus and eyes with severe or irregular astigmatism.