How to help patients save on medication costs

Both major political parties in the US are finally proposing ways to reduce healthcare costs. One party wants to build on the Affordable Care Act (ACA), while the other has repeatedly tried to overturn it.

Last week, Sen. JD Vance (R-Ohio), the Republican vice presidential nominee, floated the idea of ​​dividing chronically ill patients into different pools based on their increased risks — which would effectively bring back a worrisome aspect of pre-ACA health care coverage.

In response, Ammar Moussa, campaign manager for Democratic presidential candidate Vice President Kamala Harris, said on One of the many reasons for the attention is the high cost and expense of prescription drugs, a hot-button election issue.

Drug costs are out of control

A Commonwealth Fund report found that in 2022, at least one in 10 older adults with Medicare reported not filling a prescription because of high drug costs. Prescription drug spending rose 8.4% to $405.9 billion in 2022. Medicare accounts for a significant share of all drug spending in the United States: Medicare Part D prescription drug coverage cost about $280 billion in 2023, of which about $19 billion was out-of-pocket costs. The 10 drugs selected for Medicare pricing negotiation accounted for about 20% of total spending, or nearly $4 billion in out-of-pocket costs.

These medications are vital and not optional. Meanwhile, another analysis by the Commonwealth Fund found that U.S. retail prices — the prices charged to patients or insurers before rebates or rebates — for the drugs selected for Medicare price negotiations were between three and eight compared to other similarly sized countries Times were higher and wealth.

We must do everything we can to help patients afford their medications. It is important to understand why drug costs are rising.

Why do certain medications cost so much more in the US? There are several factors for this, including a lack of price controls. In other countries, such as France, there is a cap on pharmaceutical companies' sales growth – if sales exceed this threshold, the government receives a rebate. Patent games are another likely reason. Other countries award patents to pharmaceutical companies, granting them temporary monopolies, but in the United States, drug companies have used loopholes to extend patents.

Perhaps the most important reason, however, is the lack of a central negotiator. Other wealthy countries rely on a single negotiating body – usually the government – to decide whether to accept the price a drug company wants to charge. This leads to more bargaining power.

In contrast, in the USA, negotiations with drug manufacturers are divided among countless health insurance companies. Ironically, Medicare wields enormous power over the costs of other aspects of medical care and determines how much doctors and hospitals can be paid for their services. But only recently has Medicare been able to negotiate some drug prices directly with pharmaceutical companies under the narrowly passed Inflation Reduction Act of 2022.

Medicare provides health insurance coverage to approximately 60 million people in the United States. This year, drugmakers had the option of opting out of Medicare; If a company decided against this, it would be cut off from a large market share. If a drugmaker wanted to participate in Medicare, it had to negotiate or pay a tax penalty. All selected drug manufacturers have opted for this.

Further cost reduction for our patients

One way to further reduce prescription drug costs for our patients is to support expanded legislation that gives Medicare more power to negotiate directly with drug manufacturers. While policymakers work on legislation, there are three simple ways for us as clinicians to further reduce patients' out-of-pocket costs. I have seen patients use one or all of these methods to limit and sometimes eliminate the need for a prescription medication. Working with you – your primary care doctor or specialist – is an effective way to benefit from these strategies.

The first step is obvious: trying to prevent disease. Many chronic diseases such as obesity, high blood pressure and diabetes can be prevented through a healthy lifestyle. Of course, this is not possible in every case and for every disease, but prevention should always be the first goal.

Using generics whenever possible is also a best practice. Patents expire slowly – but eventually – and then drugs generally become much more affordable. Many chronic diseases can be effectively treated with generic drugs.

Doctors and patients should work together to find the smallest effective dose and make rapid lifestyle changes in the hope that they can eventually taper off the drug. A patient needing a medication today does not automatically mean they will need it for the rest of their life.

Patients, primary care physicians, and specialists can and should work together immediately to manage medical problems and manage drug costs. Policymakers should continue to empower Medicare to advocate for lower drug prices and more affordable health care.

Prescott Lee, MD, is a staff physician at Massachusetts General Hospital-North End Waterfront Health in Boston, an instructor of medicine at Harvard Medical School, and a Public Voices Fellow on the OpEd Project.