Pharmacists Should Be Required to Inform Patients of the Least Expensive Purchasing Option

Originally posted (10/19/2018) on Commonwealth Magazine. https://commonwealthmagazine.org/opinion/drug-costs-at-pharmacies-lack-transparency/

I am a practicing physician. Almost every time I write a prescription, I have to ask myself: “Will this patient be able to afford this at the beginning of the calendar year when they have not yet met their deductible, will they be able to afford this medicine in the middle of the calendar year when they fall into the “doughnut hole” and will they tell me if they stop taking it because it is no longer affordable?”

Despite having health insurance, many of my patients frequently cannot afford their medications either at some point in the calendar year or they simply cannot afford the “preferred” medication at any time. When my patients are unable to take their medications, their health suffers and this has cascading adverse ramifications on their family, friends, employers and the cost to our healthcare system in general.

In today’s healthcare system, it is crucially important that the physician know their patient’s out-of-pocket medication costs during the office visit because that is when one has the conversation discussing the risks (including cost) and benefits of a proposed medicine. Unfortunately there currently is no way for a physician to obtain this information during the office visit.

Recently I sent a prescription to my local pharmacy for my generic cholesterol medication. I then received a call from a pharmacy technician who informed me the cost would be $200 for a 90 day supply. As this seemed a rather high price, I logged on to GoodRx.com, Walmart and blinkhealth.com and determined that their cash price for exactly the same medicine was about $10-$70.

I called the pharmacy and asked to speak to a pharmacist. After I told them about the price discrepancy, I was informed that “you have a deductible which you will eventually have to meet.”  I said that you should have informed me, and all your clients, of the least expensive purchasing option. There was no response.

While pharmacists might argue that they will divulge the cash price of a prescription to any client who asks “what is the cash price for this medicine,” the act of asking the question requires a level of healthcare literacy which many patients do not possess. Asking that question also engenders a degree of confrontation that many people would prefer to avoid, especially with their pharmacist, who is a person they trust.

It is unconscionable that Massachusetts law does not mandate that the pharmacist disclose the lowest possible price of a prescription to the patient at the time of every financial transaction. Allowing this situation to continue also promulgates the fallacy that every healthcare decision is driven by financial ramifications and thus does a disservice to all those who strive to provide high quality/low cost healthcare.

It is morally imperative for our Governor to champion a “Truth in Pharmaceutical Pricing” bill that would require all pharmacies to inform their clients of the least expensive purchasing option during every financial transaction.

Failure to enact this legislation STAT is manifestly irrational and will have a pernicious impact on my patients’ health, finances and on our society in general.

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