Research spotlight: Investigating strategies to help clinicians and patients navigate prescription costs

Hussain S. Lalani, MD, MPH, MSc, of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital, is the lead author of a paper published in JAMA, “Strategies to Help Patients Navigate High Prescription Drug Costs.”

How would you summarize your study for a lay audience?

Prescription drugs can be expensive for patients, and many clinicians do not know how to respond when costs are too high. We reviewed the benefits and limitations of seven strategies that clinicians can use to help their patients navigate high-prescription drugs. These include co-payment cards, patient assistance programs, pharmacy coupons, direct-to-consumer pharmacies, public assistance programs, international online pharmacies, and real-time prescription benefit tools. We developed an algorithm covering how to think about the options to help patients afford their medicines based on the patient’s insurance and the drug type (brand-name vs. generic).

What question were you investigating?

Which strategies can clinicians use to help patients facing high prescription drug costs, and when is it appropriate to use each strategy?

What methods or approach did you use?

We performed a comprehensive review of available data and information about each strategy.

What did you find?

We found that co-payment cards can lower out-of-pocket costs for privately insured patients taking brand-name prescription drugs.

For uninsured individuals or those with Medicare Part D who meet financial eligibility criteria, patient assistance or public assistance programs can help to access prescription drugs at reduced costs.

All patients can forgo health insurance and purchase drugs directly using pharmacy coupons or direct-to-consumer pharmacies, which sometimes offer lower prices for generic drugs than out-of-pocket costs with using health insurance.

Online international pharmacies provide a last resort for patients who cannot afford their brand-name drugs and do not qualify for the other strategies.

Prescribers can use real-time prescription drug benefit tools through their electronic health records to estimate patient out-of-pocket costs for prescription drugs and identify alternative lower-cost medicines for insured patients, but these tools can be inaccurate or incomplete.

Finally, some of these strategies, such as copayment cards and patient assistance programs, can raise overall healthcare spending by lowering the barriers to use expensive brand-name prescription drugs even if less expensive alternatives are available.

What are the implications?

We intended this to be a useful publication for both clinicians and patients. It has the potential to help many patients access existing strategies to afford their prescription drugs.

What are the next steps?

This patchwork of strategies to address drug affordability for patients highlights the structural and policy challenges in the current U.S. prescription drug market that impede access to affordable medicines for some patients. Using these strategies may help patients afford medications in the short term, but they do not address the root causes of high drug prices.

Authorship: In addition to Lalani, BWH authors include Catherine S. Hwang, Aaron S. Kesselheim, and Benjamin N. Rome.

Paper cited: Lalani, HS et al. “Strategies to Help Patients Navigate High Prescription Drug Costs” JAMA DOI: 10.1001/jama.2024.17275

Funding: This study was funded by a grant from Arnold Ventures. Hwang received funding support from an institutional T32 National Research Service Award. Kesselheim’s work is funded by the Commonwealth Fund. The work of Kesselheim and Rome is also funded by grants from the Elevance Health Public Policy Institute, the Greenwall Foundation, and the National Academy for State Health Policy.

Disclosures: Kesselheim reported receipt of personal payments from Alosa Health. In addition, Kesselheim reported serving as an expert witness in a case on behalf of a group of state attorneys general and private insurance carriers relating to generic drug pricing, on behalf of a class of plaintiffs against Gilead in a case relating to its tenofovir-containing products, and as an expert with the Federal Trade Commission in the Amgen-Horizon merger case (now settled). No other disclosures were reported.