Nearly 29% of adults in the U.S. have reported skipping medications due to cost, leading to higher rates of complications, hospitalizations, and emergency visits. Imagine a 55-year-old recently diagnosed with high blood pressure who skips medication doses because he wants to stretch his $150 monthly prescription for a few months. He complains of worsening symptoms and starts to question the efficacy of his medication. This scenario highlights a common challenge clinicians face when patients have to prioritize finances over their health.

When patients cannot afford their prescription medications, 52% seek more affordable options through their doctor’s office. Clinicians are uniquely positioned to identify these barriers to care, educate patients about cost-saving options, and implement strategies to reduce medication expenses. Luckily, there are various ways medical offices can approach this issue, including rebates, generics, and patient assistance programs, all of which can help patients access affordable medications and achieve better health outcomes.

Understanding the Hidden Costs of High Prescription Prices

High prescription drug costs have far-reaching effects that extend beyond the patient’s wallet. When patients cannot afford their medications, adherence drops, and health outcomes suffer. Studies indicate that medication non-adherence leads to higher rates of complications, which puts added pressure not only on patients but also on healthcare systems tasked with managing preventable conditions.

For medical practices, the burden is both administrative and financial. Managing prior authorizations, appealing insurance denials, and switching medications to accommodate cost concerns consume valuable time and resources. Additionally, non-adherence often results in follow-up visits to address preventable complications, adding further strain to practices already managing tight schedules.

On the financial end, uncompensated care resulting from patients who cannot afford treatment creates inefficiencies and reduces revenue. Addressing prescription costs upfront is not just a service to patients but also a strategy to streamline workflows and improve care quality.

In 2021, a survey by CoverMyMeds revealed that 37% of patients were unaware of drug manufacturer financial assistance programs, indicating a significant gap in patient awareness regarding available cost-reduction strategies. 

Additionally, data from the Centers for Disease Control and Prevention (CDC) showed that only 19.5% of adults aged 18–64 who were prescribed medication asked their doctor for a lower-cost alternative.

This suggests that a portion of patients actively seek cost-saving options, while others may lack awareness or feel uncomfortable initiating such discussions.

These statistics highlight the need for healthcare providers to proactively inform and educate patients on the available ways to reduce prescription costs.

Quick Wins with Rebates, Discounts, and Rx Savings Programs

Rebates and discount programs provide immediate relief to patients struggling with medication costs. Manufacturer rebates, often available for brand-name drugs, allow patients to access savings through vouchers and assistance programs. Pharmacy discount cards like GoodRx and SingleCare further reduce costs by offering pre-negotiated rates at participating pharmacies.

💡 Workflow tip: Save time on prior authorizations

When insurance asks you to initiate a prior authorization for a generic medication, check the cash price on a discount card like GoodRx or SingleCare first. The affordable option can save you and your patient time!  

Clinicians can integrate these tools into their workflows by proactively discussing savings programs during patient visits. For example, staff can provide handouts with instructions on downloading savings apps or assist patients in applying for rebate programs. Additionally, some electronic medical records (EMRs) can be configured to flag rebate options based on prescribed medications, making it easier for clinicians to offer these recommendations in real time. If these are a step too far, then simply initiating these savings discussions may suffice.

Leveraging Generics and Therapeutic Alternatives

Generic medications and therapeutic alternatives can offer significant cost savings without sacrificing quality or efficacy. FDA-approved generics undergo rigorous testing to ensure they match their brand-name counterparts in safety, strength, and effectiveness. Clinicians can confidently recommend these options, which often cost 80-85% less than brand-name drugs.

Therapeutic alternatives, which include different medications within the same class, provide another path to affordability. Even when patients complain about perceived medication efficacy, is it not better that they are deriving some benefit instead of none at all?

You can address these patient concerns about generic medications by clarifying quality and highlighting successful experiences with other patients.

Recommending Patient Assistance Programs

Patient assistance programs (PAPs) provide free or low-cost medications to eligible patients, offering a lifeline for those struggling to afford prescriptions. Sponsored by pharmaceutical companies, these programs often require patients to meet income eligibility criteria, ensuring assistance reaches those most in need.

Clinicians can play a crucial role by identifying eligible patients and assisting with applications. Many programs, such as PhRMA’s Medicine Assistance Tool (MAT), simplify the process by connecting patients with relevant resources and forms. A medical practice with many low-income patients can streamline this process by designating staff members to manage PAP applications and track approvals. Providing patients with written instructions or digital resources can further simplify participation.

For example, a single parent managing diabetes may qualify for a PAP, which can reduce monthly medication expenses significantly. By removing financial barriers, the patient can focus on consistent treatment and improving their health outcomes. Some tools like GoodRx have a HCP mode with a prescription savings flow that customized to help doctors and other prescribers find coupons with exclusive manufacturer discounts, manufacturer copay cards, and patient assistance programs all in one place.

Embracing Unconventional Strategies

Innovative approaches, such as using bulk orders, mail-order pharmacies, and in certain cases, clinical trials, offer additional ways to reduce prescription costs while improving adherence and outcomes.

You may wonder how a patient struggling to afford a 30-day medication supply could manage a 90-day supply. The answer lies in incentives and convenience: insurers and pharmacies often offer discounts for bulk purchases, reducing the cost per dose and minimizing trips to the pharmacy.

• 90-Day Prescriptions: Insurers and pharmacies often offer discounts for bulk purchases, reducing the cost per dose and minimizing trips to the pharmacy. 90-day supplies can cost almost half as much as a one-month supply.

• Mail-Order Pharmacies: These services offer convenient delivery options, often with lower costs for maintenance medications. Some common ones are costplusdrugs.com or Amazon Prime’s prescription services.

• Clinical Trials: Patients may qualify for free or low-cost medications through trial participation. Additionally, practices can now earn revenue while matching patients to clinical trials. Hint: This is part of what we do at Novelcare.

• Medication Samples: Offer samples of new prescriptions to patients as a short-term solution while exploring affordable long-term options.

• Prescriptions for over-the-counter (OTC) medications: Even when recommending an OTC medication, providing a prescription allows patients to use discount cards to reduce costs.

By combining these strategies, medical practices can further enhance patient care while addressing cost concerns.

Learn More

Novelcare’s software integrates with EMRs, helping providers find eligible patients for clinical trials. Medical practices can provide access to promising treatments and earn additional revenue at the push of a button.

Get on a call with a Novelcare team member to simplify clinical trial matching and enhance outcomes for your patients and practice.