Prices for Prescription Medications Vary Widely Depending on Where a Patient Lives – What Can Be Done About it?
The rising cost of prescription medications continues to be one of the fastest-growing expenses in healthcare for consumers, health plans, and employers. Traditionally, physicians were unaware of what prescription price their patients would encounter at the pharmacy counter. This was one of the most important factors that led to the phenomenon of prescription abandonment. According to multiple sources ranging from 2014-18, nearly a third of prescriptions are either not filled or not taken as directed due to cost.1,2
Medication prices can significantly vary from pharmacy to pharmacy, as well as by geography. While the difference in price is typically minimal across competitive pharmacies for an over-the-counter product like lip balm, the same is not always true for prescription medications. For example, when you consider the cost of a product at a drug store chain in Mississippi versus the cost of that same product cost at another drug store chain in California, you may observe a price variation. This extends beyond prescription medications to include over-the-counter medications or even just a bottle of water, which can cost more in one region of the country versus another.
The same principles apply in purchasing medications without using an individual health plan. GoodRx, a Veradigm partner, is a leading company that provides up-to-date information on the out-of-pocket cash price (non-pharmacy benefit) of medications by quantity and location.3 In a recent report by GoodRx, a cost location analysis of the 30 most populous US cities showed that prescription drug costs are highest in New York (17% higher than national average) and lowest in Indianapolis (11% lower than national average). These price variations can occur within the same city block, the same state, or as far as across the country. According to the report, some of these price differences can be attributed to overall cost-of-living differences and the variation of big-box retailers in some areas.4
So that’s life, no? Nothing to be done for a person who happens to live in an area that is more expensive than average but to accept that they are going to pay more, right?
Those sentiments may have been accurate a few years back, but with prescription price transparency technologies like Veradigm RxTruePrice™, any prescriber that has access to the internet can obtain a patient’s specific out-of-pocket cash price and insurance pricing for any medication, at all local pharmacies, so that patients are now able to make the most informed possible decision. Together, providers and their patients can ensure that, while a city may be more expensive than average, the cost for medication can be as low as possible for that area.
It is important to understand that cash pricing and insurance pharmacy benefit pricing are not an apples-to-apples comparison. If a patient fills a prescription using their insurance coverage cost, the insurance company will usually not cover the medication again until close to the end of the total supply period (usually 30- or 90-day supply). If a patient happens to go on vacation 10 days after a fill and forgets their medication at home, the health plan will reject the request by saying “refill too soon”. In this case, if refills are available, its up to the discretion of the pharmacist to fill a short supply of the medication to provide enough to hold the patient over until returning home. This short supply could cost more than the copay of the entire amount of medication received 10 days before.4
This is the type of real, out-of-pocket cost consideration that, when combined with prescription price information that’s specific to each patient, their pharmacy benefit, and pharmacies, can help the patient and their doctor to make an informed decision to help minimize the cost of a medication, regardless of where you live.
To learn more, look into Veradigm ePrescribe or simply contact Veradigm at https://veradigmhealth.com/ for more information on ways to save money on prescriptions.
4https://www.sfchronicle.com/business/article/Prescription-drugs-cost-14-more-in-SF-than-13812110.php
Tom Pasquariello, PharmD, BCPS, BCMAS, PRS
Tom Pasquariello, PharmD, serves as a Clinical Informatics Pharmacist for Veradigm. He graduated from Campbell University College of Pharmacy and Health Sciences in 2008. After serving as a hospital and community-based pharmacist for 7 years, Tom joined Allscripts in 2015. As the Veradigm clinical informatics pharmacist, Tom serves as a thought leader for Clinical Workflows, Practice Fusion, and Payer Health markets. He also manages the Allscripts’ Medi-Span content relationship for all medication related issues. Tom publishes a weekly newsletter to the Veradigm product management, sales, and payer teams. This newsletter provides insight on new FDA approved medications, relevant medical news, pharmacy benefit management (PBM) updates, and new genetic therapies. By connecting the Veradigm team and our external sales partners, the weekly newsletter helps the team stay on the forefront of medical updates, exceeding the needs our clients and ultimately helping to provide better care to each patient.