Saving Money on Medicines. Angela Clark, RHIA

Transcription

1 Saving Money on Medicines Angela Clark, RHIA

2 OUTLINE People s pharmacy podcast 10 ways to save money on medicines Why drugs cost so much Future: American Patients First Plan

3 How Can We Save Money on Medicine? Peoples Pharmacy podcast: Show the podcast/

4 10 Tips for Saving Money on Medicine from The Graedons' guide to: Saving Money on Medicines 1. Whenever you can, make changes to your lifestyle that may help reduce the number of prescription drugs you need to take. Exercise, weight loss, healthy food and relaxation techniques are all very effective for helping to reduce blood pressure, cholesterol, anxiety, depression, and insomnia.

5 10 Tips for Saving Money on Medicine from The Graedons' guide to: Saving Money on Medicines 2. Consider non drug alternatives such as home remedies and dietary supplements. You may find that vinegar and Listerine soaks or topical Vicks VapoRub are as good for fighting toenail fungus as prescription Jublia, with the added virtue of being much cheaper. Coconut water, almonds, chewing gum, fennel, yellow mustard or DGL (deglycyrrhizinated licorice) may ease heartburn without the cost or side effects of PPI drugs. Resources: Peoplespharmacy.com Consumerlab.com

6 10 Tips for Saving Money on Medicine from The Graedons' guide to: Saving Money on Medicines 3. Talk to your doctor and pharmacist about over thecounter drugs, which are often far less expensive than prescription medications, and frequently equally as effective. (allergy, GERD) Over-the-Counter Prescription $4.79 $14.99

7 10 Tips for Saving Money on Medicine from The Graedons' guide to: Saving Money on Medicines 4. Discuss your cost concerns with your doctor, and ask him/her to consider prescribing the most costeffective medication for your condition. There may be several options available to you. Also talk to your doctor and pharmacist about whether or not it is safe for you to split your pills. Narrow therapeutic index drugs are not safe to split.

8 10 Tips for Saving Money on Medicine from The Graedons' guide to: Saving Money on Medicines

9 Narrow Therapeutic (NTI) Drugs Narrow therapeutic index drugs are drugs where small differences in dose or blood concentration may lead to serious therapeutic failures and/or adverse drug reactions that are life threatening or result in persistent or significant disability or incapacity. If you are taking a NTI drug take the brand version. If you have to switch to the generic NTI drug monitor your side effects and subjective responses and keep careful records of your lab results and your numbers (blood pressure, blood sugar, etc., depending on what medication you re taking) and notify your doctor. If you respond well to the generic then stick with the same manufacturer, don t switch to another generic.

10 Examples of NTI Drugs* Generic Brand Generic Brand amiodarone carbamazepine clindamycin clonidine cyclosporine digoxin divalproex ethosuximide isoproterenol levothyroxine Cordarone Tegretol Cleocin Catapres Sandimmune Lanoxin Depakote Zarontin Isuprel Levothroid, Levoxyl, Synthroid lithium phenytoin prazosin primidone procainamide quinidine gluconate quinidine sulfate theophylline valproic acid Eskalith Dilantin Minipress Mysoline Pronestyl Quinaglute Quinidex Theo-24, Theolair, Uniphyl Depakene warfarin Coumadin, Jantoven Use the brands for these drugs when possible. If you must use a generic form, try to stick with one manufacturer. Monitor your reactions carefully, and report anything unusual to your doctor immediately.*peoples Pharmacy

11 10 Tips for Saving Money on Medicine from The Graedons' guide to: Saving Money on Medicines 5. Find out if you qualify for free medicine. The pharmaceutical industry has a program for helping those in serious financial need get their prescription medications. Visit the website for the maker of the drug. If turned down because you don t meet the financial requirements appeal. Helpingpatients.org Needymeds.org Panfoundation.org

12 10 Tips for Saving Money on Medicine from The Graedons' guide to: Saving Money on Medicines 6. Shop around! Prices vary between pharmacies and online services. Secret shoppers for Consumer Reports surveyed over 200 pharmacies around the country. What they found was shocking: In short, prices can vary widely from retailer to retailer, even within the same ZIP code. Drugs could cost as much as 10 times more at one retailer vs. another. Goodrx.com Blinkhealth.com

13 10 Tips for Saving Money on Medicine from The Graedons' guide to: Saving Money on Medicines 7. Haggle! Americans negotiate the price of a new or used car. What they don t realize is that it is also possible to negotiate with a pharmacist about the price of medicine. Consumer Reports suggests asking, Is this your lowest price? This is especially true if you pay out of pocket. Do not rule out independent pharmacies. They may beat the chains and are more likely to negotiate. See if your pharmacy offers price matching.

14 Authorized Generic Drugs Authorized generics may be a solution to the dilemma of mistrust surrounding some generic drugs. The brand name manufacturer makes a deal with a specific generic company to supply its drug directly or provides the generic maker with exact instructions on how to duplicate the brand name product. Ask the pharmacist if there is an authorized generic OfficeofMedicalProductsandTobacco/CDER/UCM pdf

15 10 Tips for Saving Money on Medicine from The Graedons' guide to: Saving Money on Medicines 8. If your insurance company requires that you take a generic drug, ask your pharmacist to seek out the authorized generic which should be identical to the brand name. It may even be made on the same production line. Though it might be a bit pricier than other generics, it will be far less than the brand name. Authorized generics are especially important if your medicine has a narrow therapeutic index. When taking a generic drug always monitor your reactions (both lab records and subjective responses). Also, it might be cheaper to pay out of pocket rather than use insurance.

16 Brand vs Generic Doctors will sometimes give you samples to see if the drug helps. If it does and it is expensive you might ask the doctor if there is generic. Monitor effectiveness and side effects. If the generic work as well ask the doctor to change prescription to the generic drug.

17 Use Generic Drugs Wisely If you are switched to a generic version, pay attention to your body. Keep track of side effects and also keep a record of how well the drug is working blood pressure measurements, blood sugar readings, thyroid lab results, INR numbers, etc. If you have any suspicion that your generic is not working as it should, experiment. Switch back to the brand name for a month and see how you do. Be sure to keep records during this period to see if there really is a difference. If there is, you may need to show your data to your doctor or insurance company. Trust yourself. Don t take the pharmacist s or the doctor s word for it that the generic is just like the brand name drug. Fillers, binders and colors can vary among generic formulations and they may have an effect on you.

18 Drugs to Treat Overactive Bladder Drug (one month supply) Generic Brand Tolterodine (Detrol, Detrol LA) $34.34 $ Oxybutynin (Ditropan XL) $25.86 $ Oxybutynin as a skin patch (Oxytrol) None $ (8 patches; 2 per week) Oxybutynin gel (Gelnique, Gelnique 3%) None $ Trospium (Sanctura) $31.11 $ Solifenacin (Vesicare) None $ Darifenacin (Enablex) $91.70 $ Mirabegron (Myrbetriq)* None $ Fesoterodine (Toviaz)* None $ * Samples Pricing resource goodrx.com

19 E-Prescribing (E-RX Program) Medicare requires doctors to e prescribe medications The pharmacy where drug is e prescribed might be more expensive than other pharmacies Ask for both an e prescription and a printed prescription so you can do your own research. Physician s don t have time to research your insurance and the cost of a drug

20 10 Tips for Saving Money on Medicine from The Graedons' guide to: Saving Money on Medicines 9. Control your quantity. See if you can try a free sample when you start a new drug to make sure that you can tolerate it and that it works for you. If you can t get a sample, ask your pharmacist to dispense a trial dose. If you decide to go ahead with the prescription, you might save money by buying in bulk from big box pharmacies like Costco. Consumer Reports found that Costco offered great prices and you don t have to be a member to buy Rx drugs there. During the open enrollment time period of your insurance plan make sure your medications are covered. Plans change drug coverage from year to year.

21 10 Tips for Saving Money on Medicine from The Graedons' guide to: Saving Money on Medicines Shop online. Consumer Reports suggests GoodRx.com to learn a drug s fair price. Visit PharmacyChecker.com and CIPA.com to find verified Canadian pharmacies. This may be especially important if you need to take a brand name medicine that is prohibitively expensive in the U.S. and is a narrow therapeutic index drug.

22 10 Tips for Saving Money on Medicine from The Graedons' guide to: Saving Money on Medicines Have your doctor review all your medications at least annually and see if there is anything that you are taking that can be eliminated or reduced. If you are taking a lot of medicines and don t understand what they are for ask the pharmacist to sit down and help you manage your medications. This is free for Medicare and Medicaid patients.

23 Rxoutreach.com Non-profit that provides low cost drugs to people on limited income.

24 Pillpack.com

25

26 Why so Expensive? Patents last 20 years Medicare Part D in 2006, pharma lobbyists convinced legislators that giving Medicare negotiating power would amount to price control VHA can negotiate prices and they pay 80% less Most insurers work with pharmacy benefit managers who negotiate discounts with drug companies (another administrative layer) 9 out of 10 big pharma companies spend more on marketing than on research

27 History of Drug Pricing Pharmaceuticals used to be one of the best deals in medicine. Prices rarely rose from one year to the next. Some years they even dropped. Starting in 80 s prices began skyrocketing. Many of these medications have been on the market for decades (Premarin has been sold since 1942; Valium since 1963). If other consumer products followed big Pharma s example, a car sold in 1975 at an average price of $5,000 might now cost as much as $500,000.

28 Drug Prices 1975 to 2015

29 10 yr old Trevor Foltz Infantile spasms

30 DRUG ACTHAR (Mallinckrodt) Invented in the 1930s $40 a vial in 2000 to $39,000 in 2018 Round of treatment $125,000 (5 vials at $23,000 each) This sharp jump in Acthar's price outraged families, doctors, pharmacists and hospitals and led Danielle Foltz to testify before Congress against the increase.

31 DRUG ACTHAR (Mallinckrodt) $100 million settlement between the government and the drugmaker as well as revelations that Medicare has spent nearly $2 billion covering Acthar prescriptions for seniors while the drugmaker paid millions to prescribing doctors. The exorbitant price also forced doctors and hospitals to question whether a $20 (Prednisolone) alternative would work just as well. The skyrocketing cost of Acthar led to huge increases in revenues for the drugmakers, Questcor and Mallinckrodt, not because of any breakthrough in treatment, critics say, but as a result of higher prices, aggressive marketing and an alleged effort to thwart all competition. That allegation is what led to the government's case against Mallinckrodt, which purchased Questcor in Mallinckrodt settled without any admission of wrongdoing.

32 Open Payments Data Program Open Payments is a national transparency program that collects and publishes information about financial relationships between the health care industry (i.e. drug and device companies) and providers (i.e. physicians and teaching hospitals). These relationships may involve payments to providers for things such as research, meals, travel, gifts, or speaking fees. One of the ways that the Centers for Medicare & Medicaid Services (CMS) provides data to the public is through this search tool, which allows the public to search for physicians and teaching hospitals receiving payments, as well as companies that have made payments.

33 Mallinckrodt PAYMENTS

34 Mallinckrodt PAYMENTS

35

36

37 Pfizer

38 Pharmacy Benefits Managers (PBM) Xtandi a drug for prostate cancer de-listed in

39 Pharmacy Benefits Managers (PBM) Xtandi a drug for prostate cancer de-listed in

40 Pharmacy Benefits Managers (PBM)

41 THE FUTURE

42

43

44 Alex M. Azar II, Secretary of Health and Human Services U.S. Department of Health and Human Services (HHS) on President Trump s Drug Pricing Plan before Committee on Finance Tuesday, June 26, :00 We face four significant problems in the pharmaceutical market: 1. high list prices set by manufacturers; 2. seniors and government programs overpaying for drugs due to lack of the latest negotiation tools; 3. rising out of pocket costs; 4. and foreign governments free riding off of American investment.

45 American Patients First 1. Create the right incentives for list prices. Everybody in today s system makes money as a percentage of list prices, including pharmacy benefit managers, who are supposed to keep prices down. Everybody wins when list prices rise except the patient, whose out of pocket cost is typically calculated based on that price. Require drug companies to include their list price in advertisements. For example, Americans deserve to know the price of a wonderful new drug they hear about on TV before going to ask their doctor about a product they may find unaffordable. Second, we need better negotiation for drugs within Medicare that is what President Trump has promised, and it s what we re going to deliver. 2. In Medicare Part D, HHS will work to give private plans the market based tools they need to negotiate better deals with drug companies. Part D is a tremendously successful program, but it has not kept pace with innovations in the private marketplace. We also want to bring negotiation to Medicare Part B, physician administered drugs. Right now, HHS just gets the bill, and we pay it. This system may actually be driving doctors to prescribe more expensive drugs, while potentially tempting manufacturers to develop drugs that fit into Part B rather than D. We are going to look at ways to merge Part B drugs into Part D and leverage existing private sector options within Part B.

46 American Patients First 3. We need a more competitive pharmaceutical marketplace. Thanks to the reforms Congress passed in the 1980s, America has the strongest generic drug market in the world. But there are many ways that manufacturers still unfairly block competition. Since the rollout of the President s blueprint, FDA has publicized the names of companies that may be abusing safety programs to block competition, and issued new guidance to help lessen the effects these actions may have on generic access. 4. We need to bring down out of pocket costs for American patients. Since the blueprint rollout, CMS has reminded Part D plans that it is unacceptable to have gag clauses barring pharmacists from working with patients to identify lower cost options. More broadly, we will work to ensure patients know how much a drug costs, how much it s going to cost them, and whether there are cheaper options, long before they get to the pharmacy counter.

47 anpatientsfirst.pdf