Does your doctor think about what your medication costs will be when prescribing your MS meds?
A few months ago I wrote a post about why some people stop, or skip, their MS meds. One of the reasons is that they can’t afford the out-of-pocket MS medication costs. A suggested solution is to talk with your doctor about cost whenever a new medication is suggested. But, according to the Centers for Disease Control only about 20 percent of patients do that. Wouldn’t it be better if your doctor checked to see if you can afford a med before prescribing it?
Software can see medication costs, but…
I’ve just read about a software tool that some doctors have available that makes it easier for them to see the cost of those MS meds. According to an article by Phil Galewitz in Kaiser Health News, the tool is part of the electronic health record system these physicians use. With just a few mouse clicks, they can see how much your out-of-pocket medication costs will be, start the process of getting insurance approval for the medication, and find a lower-cost alternative, if there is one. But not many doctors are using it.
According to the KHN article, the Humana healthcare system has had this pricing tool available on its network for about four years. Yet, fewer than 10 percent of its physicians are using it. Some may simply not want to take the time. But it may also be possible that health insurance companies are not sharing the co-pay information that the app searches. Or, the database in one electronic health records system may include information for some health plans and not for others.
A failure to communicate
The KHN article cites the example of a drug pricing tool sold by Surescripts, which is partly owned by CVS Caremark and Express Scripts. The tool includes data from those companies, but not from OptumRx, which is owned by UnitedHealth. The OptumRX drug pricing tool, on the other hand, includes data from Optum, but not from Express Scripts or CVS.
“It’s a chicken-and-egg thing where doctors don’t use it because they don’t have the data for all their patients, and health plans don’t promote it to physicians because doctors don’t have the technology in place,” health information technology consultant Anthony Schueth told KHN.
The U.S. government is taking steps to ensure that doctors can access this available co-pay information, but it will only be for Medicare patients and it won’t be available until 2021. That’s when each company providing Medicare medication insurance will be required to have what’s called a Real Time Benefit Tool integrated into the ePrescribing or electronic health record systems that doctors use.
We need to ask “what will this medication cost?”
In the meantime, we should be our own advocates and initiate a brief conversation about our MS medication costs with our physicians. Though the doctor may not have the information at hand, the office staff can probably get it. Even if it can’t, you’ve at least made your healthcare provider aware that cost should be a consideration when a medication is prescribed. After all, what’s the point of prescribing a treatment if you’re going to skip doses in order to afford it?
(Featured image by Kevin Schneider from Pixabay)
(A version of this post first appeared as my column on the MS News Today website).
