Medication access Replies

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DISCUSSION POST # 1Reply to Nozomi

The cost of prescription medications continues to rise in the United States, and cost-related medication underuse (CRMU) is a major healthcare issue (Miranda et al., 2019). CRMU refers to a situation in which patients take less medication than prescribed or skip doses altogether due to their inability to pay for those medications (Miranda et al., 2019). The prevalence of CRMU in people over the age 55 in the United States is estimated to be 16.8% in 2014, which is higher than other high-income countries (Miranda et al., 2019). Some of the risk factors for CRMU are multiple diagnoses, being under the age 65 years, lack of insurance prescription coverage, and low household income (Miranda et al., 2019). In order to ensure medication compliance and to improve patient outcomes, it is imperative that healthcare providers are aware of how to make medication more accessible to their patients.

            Fiscella et al. (2019) suggest that the first step in preventing CRMU is through routinely asking patients if they have any difficulties in purchasing their medications. In addition, some methods to contain the out-of-pocket cost for the patient is to recommend the use of generic medications, and to routinely de-prescribe by discontinuing unnecessary medications (Miranda et al., 2019). Additionally, the provider may offer extended prescriptions, such as three-month supply, as well as manufacturer discounts and coupons, in order to reduce the cost burden to the patient (Fiscella et al., 2019). For example, Walmart offers $4 prescriptions for an array of prescription medications, including diabetes and thyroid medications (Fiscella et al., 2019). This information can be found at 
https://www.walmart.com/cp/4-dollar-prescriptions/1078664. Other websites, such as goodrx.com, may offer significant discounts on prescription medications, which may also be helpful for many patients. If patients need additional assistance, there are free medication programs, such as needymeds.org and rxoutreach.org (Fiscella et al., 2019). Furthermore, certain federally funded community clinics have contracts that allow them to offer significantly discounted or free prescription drugs for low-income individuals (Fiscella et al., 2019). 

            The actual price that the patient needs to pay for a prescription drug is determined by the patient’s insurance company, rather than the manufacturer, distributor, or the pharmacy (Miranda et al., 2019). For the uninsured patients, as well as some branded drugs, the price depends on the pharmacy (Miranda et al., 2019). Thus, pharmacies are an important part of the care team, and it may be helpful for the provider to be aware of the local pharmacy options, and the cost of some common medications in those pharmacies. In some cases, it may be necessary for the office to check with the pharmacy regarding the availability and coverage of medications, if it is very difficult for the patient to do this independently.