The majority of Americans who buy prescription drugs say they are concerned about the costs of their medications, but most are unaware of how much their new prescriptions cost and whether there are lower-cost options, according to a national survey sponsored by insurer UnitedHealthcare.
Consumers' unfamiliarity with lower-cost options and generic alternatives means that consumers might be missing out on significant out-of-pocket savings. For example, UnitedHealthcare estimates that in its plans there could be an annual health care savings of $1.1 billion, including more than $490 million saved on co-pays, if fully insured plan members switched to lower-cost options such as generic equivalents.
The survey highlights a troubling trend: Thirty percent of respondents indicated that the high cost of prescriptions had caused them to skip doses or not take their medication.
Among other findings from the survey, which was conducted in August 2010:
• 60 percent of consumers who purchase prescription drugs are concerned about the costs of their medications, yet nearly 70 percent of this group doesn’t always know how much their prescription will cost before they purchase it.
• 94 percent said they would change to a lower-cost medication if the prescribing physician presented two drug options that were interchangeable or equivalent medically.
Information on Cost-Saving Options
The survey indicated that a majority of Americans who buy prescriptions are interested in learning more about lower-cost options. According to UnitedHealthcare, ways to helping employees better understand the costs of medications so as to reduce their prescription drug spending while maintaining clinical effectiveness include:
• Placing clinically and economically advantageous drugs on lower tiers that require minimum or no co-payments. "If consumers choose to take a higher-cost drug when an equally effective, lower-cost alternative is available, logically that should cost the individual more money," commented Timothy Heady, CEO of UnitedHealth Pharmaceutical Solutions. "The idea of putting drugs into different co-pay tiers is one way we can communicate to plan members differences in value, motivating them to consider higher-value choices."
• Creating customized communications (letters, e-mail, phone calls) to inform participants about their options for potential savings. Heady pointed out the need to "help individuals recognize alternatives, when available, to high-cost drugs they might currently be taking, and to provide them with support and advice on how to pursue other choices."
• Providing retail pharmacists with plan participant-specific messaging on effective and appropriate lower-cost options. "Working directly with retail pharmacists is one means to better inform consumers,” Heady noted. As a prescription is entered, "pharmacists can be informed about alternative choices and cost savings so they can discuss lower-cost options with plan members at the point of service. With the member's consent, the pharmacist can contact the prescribing physician for approval of an alternative medication then and there," or, in some cases, can provide a recommendation that the consumer can make without a physician's approval. "We've seen good evidence that's having a much more meaningful impact on decision-making" than just providing consumers with written communications, Heady said.
• Making available a half-tablet (pill splitting) program that reduces co-pays by 50 percent. As a safeguard, "once we determine that a particular drug meets all the clinical and safety requirements for splitting, we still require that the physician write the prescription stating that the tablets are to be split," Heady noted (to learn more, see the SHRM Online article "Splitting Pills Can Cut Costs, but Only When Appropriate").
"We've seen very good uptake from our members who are aware of the half-tablet program," Heady added, especially when pharmacists are involved. "When we don't provide any assistance at point of service in the pharmacy, we typically see 10 to 12 percent of our members take advantage of that option. Where we provide some assistance to the pharmacist at the time the prescription is filled, we see that number move up to as much as 30 percent," he elaborated.
Stephen Miller is an online editor/manager for SHRM.
Splitting Pills Can Cut Costs, but Only When Appropriate, SHRM Online Benefits Discipline, May 2010
Individuals' Behavior Costs Billions Annually in Pharmacy Costs, SHRM Online Benefits Discipline, April 2010
Drug Coverage: Cost-Saving Tactics for Prescription Drug Benefits, SHRM Online Benefits Discipline, November 2006
SHRM Online Benefits Discipline
SHRM Online Health Care Reform web page