Maria Greenwald, MD: How to Help Patients Save on Prescription Costs

For many clinicians, regardless of specialty, the questions that arise from patients about their treatments are often more similar than not.

Most questions are straightforward and could pertain to the efficacy, safety, and administration of treatments—yet, there is often an area where some feel they fall short in informing their patients and that is how much will this cost or can they get it cheaper elsewhere.

That very issue is what compelled Maria Greenwald, MD, rheumatologist with Desert Medical Advances, to study how she could improve her knowledge to better serve her patients. The results of that study were presented by Greenwald during the Clinical Congress of Rheumatology (CCR) West 2019 annual meeting in San Diego, CA.

Greenwald’s study examined a cohort of 482 rheumatoid arthritis patient visits over a 6-month period, which lasted from January 1, 2019 until July 1, 2019. Results of the study revealed that 80% of patients expressed concerns about the cost of a drug and its accessibility. Additionally, 2 patients per week reported that insurance had denied a refill despite prior coverage.

Through a review of literature which included business quarterly reports and list prices in the Medical Letter, Greenwald and her colleagues identified 5 options that might allow a patient to reduce the cost burden of biologics and DMARDs. Those options were recommending a patient check GoodRx.com for best cash price, recommending switching to Medicare Part D, posting a list of the costs for 10 to 15 biologic medication in the exam room, directing them to Veterans Affairs is they were a veteran, and directing the patient to contact the pharmaceutical manufacturer for patient support.

After presenting the information during a poster session at CCR West 2019, MD Magazine® caught up with Greenwald to discuss how clinicians can help their patients who may have questions about the cost or accessibility of their treatments.

MD Mag: What are some ways clinicians can offer guidance to patients on how to save money on expensive treatments?

Greenwald: In my practice, I commonly get asked "How much will this cost, doctor?" So, I'm writing the prescription, I make the diagnosis, but then I'm asked the tough question and I find many times I'm ignorant because I don't know how much it's going to cost this patient. So, in the last year or 2 we've checked to try to come up with ways to save patients some money and, as much as we can, find out if they can afford their medication.

So, one method is to ask patients to go to GoodRx.com, which is available on your phone, and you put in the zip code and it'll give you the best cash price for different drugs. My medication could be $60,000 a year, which we have to do other things, but I can help them with their statin, hypertensive drugs, insulin, and all of those add up so that they can put more money into their deductible or something else. So, it's a way of making their medical dollars go farther.

Another way is to ask the patient if they're a veteran. They don't always realize it but I can write the prescription (and) if they're a veteran I can hand the prescription to them to take to the VA and it's often much cheaper for them to do it that way.

Another way to do it is to ask the patients look at the actual prices and they can look through all those prices and see what might be more affordable for them and they can also talk to—I use the reference librarian at our public library. So, I send the patient over to the public library with a list of all the prices of biologics and the reference librarian calmly and sweetly goes through all the different medications with that patient's insurance plan so they can find out what's on the formulary. I can't do that in the office, but the reference librarian is paid by tax dollars in the community to research things for people who live in the community and they've been very helpful.

Another thing is if they're Medicare you can ask them to look at all the different plans to see what they can afford and change plans in October. They may have to change plans every October, but a Medicare that can't be turned down—there's no refusal to cover a Medicare, but they may have to change which Part D is covering their medications. So, these different ideas come up you can also ask the patient to check with the pharmaceutical company that produces their drug to see if there's patient support. I can't predict that, but that's another thing you can ask the reference librarian to look up on the computer for your patient.