Reducing Medication Costs with Chronic Care Management (99490)

According to the Centers for Disease Control and Prevention, approximately 18 percent of the $263 billion spent on retail prescription drugs in the United States was paid out of pocket ⁽¹⁾. In a National Institutes of Health survey of Medicare beneficiaries who did not fill at least one prescription, 55.5 percent reported they thought the medicine would cost too much and 20.2 percent believed it was not covered by insurance ⁽²⁾. Persons with chronic conditions account for 91 percent of all prescriptions filled, and several chronic conditions (e.g. epilepsy, diabetes mellitus, cancer, Parkinson’s disease, and others) have elevated costs associated with medications ⁽³⁾. For this reason, notably, 15 percent of patients have asked a doctor for a lower-cost medication to save money ⁽¹⁾.

Patients enrolled in Chronic Care Management should be assessed for medication adherence and assisted with reducing their medication costs. To make this possible, CCM coordinators should be trained to recognize barriers to optimum health and locate resources for their patients.

Recognizing Barriers

Open communication between CCM coordinators and patients should allow for disclosure of daily barriers. Patients may disclose financial strains associated with food supplements, household utilities, and/or healthcare-related expenses. Routine assessment of medication adherence and treatment plan compliance may help identify patients in need of more cost-effective care.  Coordinators may experience statements from CCM patients such as the following:

• I did not pick up that new medication from the pharmacy.
• I take my medication every other day instead of daily.
• I could not take that medication anymore.
• I have been researching other options for treating my condition.
• I want to ask my doctor about another medication instead of that one.

Consider the following case example of a CCM patient with hidden elevated medication costs and home expenses:

Mrs. Brown is seventy-years-old with arthritis, hypertension, and a new diagnosis of diabetes mellitus. During her first communication with her coordinator, Mrs. Brown says that she has stiffness in her knees and swelling in her feet every morning. The coordinator asks Mrs. Brown about her current medication regimen, and Mrs. Brown reports that she takes Lasix and Naproxen, daily, for the disclosed symptoms, but has not been taking her new diabetes pill. At this point, the coordinator should ask about the patient’s daily self-management methods for blood glucose control as well as any financial barriers she might be experiencing.

Although Mrs. Brown reports less energy lately with blood glucose levels over 250, she says she is unable to continue paying the costs for the medication. She says she is on a fixed income and has difficulties paying for food and utilities. The coordinator should locate resources for patient assistance options such as food pantries and benefit programs. The CCM coordinator will also communicate Mrs. Brown’s changes to her primary care provider and in turn, relay received instructions for Mrs. Brown to implement as necessary. Mrs. Brown speaks with her CCM coordinator after receiving help applying for food supplements and medication cost assistance programs. Mrs. Brown can now take all of her medications as directed, and reports less financial strain, with improved daily self-management of chronic conditions.

Resources for Medication Assistance

By 2025, chronic diseases will affect an estimated 164 million Americans – nearly 49 percent of the population, according to an article addressing chronic disease in the United States ⁽³⁾. Lack of health insurance coverage and poverty are recognized risk factors for not taking medication for these conditions as prescribed due to cost ⁽¹⁾. This cost-saving strategy may result in poorer health status and increased likelihood of emergency room visits and hospitalizations, as compared with adults who follow their recommended medication regimens ⁽¹⁾. To help prevent these outcomes, Chronic Care Management coordinators should locate resources for patients in need of assistance.

Discount cards, medication coupons, and generic medications are some options for reducing medication costs for CCM patients. CCM coordinators should also be proactive in helping patients benefit from eligible programs (e.g. Good Rx, Needy Meds, and Benefits Checkup) to compare costs of medication amongst pharmacies and potentially assist with co-pays for medications.  These efforts for cutting medication costs should be individualized, with a goal of relieving financial strains, reducing daily stressors and improving health outcomes for participants.

References

1. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. [Online] January 29, 2015. [Cited: December 14, 2016.] https://www.cdc.gov/nchs/data/databriefs/db184.htm.
2. US National Library of Medicine National Institute of Health. [Online] [Cited: December 14, 2016.] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/.
3. The Growing Crisis of Chronic Disease in the United States. s.l. : Partnership to Fight Chronic Disease, 2007.