Controlling Out-of-Pocket Drug Costs Key to Improving Patient Outcomes

Controlling the costs of prescription medications for patients with chronic illnesses is at the forefront of almost every stakeholder’s agenda in healthcare. Increasingly, efforts are being made to incentivize providers to engage with patients in financially responsible decision making.

WellPoint, one of the largest insurance companies in the United States, said it would offer oncologists $350 per month for each patient that was prescribed one of the company’s recommended treatment regimens. The program is intended to standardize care delivery methods by providing treatment regimens which reduce wasteful spending and offer patients maximum health benefits.

Although such programs remain controversial among some practitioners in the oncology community, most recognize that large efforts are needed to control the rising costs of cancer treatment. Last year, the United States spent $37 billion on cancer drugs, and newer varieties can cost up to $100,000 for 1 round of treatment.

“Oncologist reimbursement at the moment is a broken system,” said Richard Schilsky, MD, FASCO, chief medical officer of the American Society of Clinical Oncology.

A recent study in The American Journal of Managed Care also found that financial stress can keep many patients from getting treatment or adhering to their medications. In particular, authors Didem Minbay Bernard, PhD, Patrik Johansson, MD, MPH, and Zhengyi Fang, MS, focused on patients with hypertension. They found that it is important for providers to recognize that their patients’ financial burdens can impact their treatment outcomes.

“Hypertension represents the most common reason for office visits to primary care physicians. However, recent studies show that 80% of physicians are unaware of medication costs and also misunderstand the complexities of health coverage,” the authors said in an official release. They add that health plans can adopt measures which would reduce of out-of-pocket costs for patients where there is strong evidence that treatment works for chronic illnesses such as hypertension.

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Insurers Push to Rein In Spending on Cancer Care [The Wall Street Journal]