(UroToday.com) The 2024 Southeastern Section of the AUA (SESAUA) annual meeting featured a State of the Art Lecture by Dr. Ruchika Talwar discussing online tools to decrease out-of-pocket prescription costs for our urology patients. Dr. Talwar started by emphasizing that the objectives of this presentation are not to solve America’s problem of unaffordable prescription medication, nor is it to discuss why treatment prices are so high in America and figure out who is to blame, but rather to be able to provide guidance for when patients ask their provider “Doc, what will this prescription cost me?”
The scope of the problem is that prescription medications cost $348.4 billion annually. Only 20% of physicians can accurately estimate patient out-of-pocket costs, yet 9 in 10 patients over the age of 65 want their physician to do so. The main barrier is that it is a convoluted and complicated system, and often, no two patients pay the same out-of-pocket costs. Most patients purchase prescription drugs via an insurance benefit or purely pay cash for medications. Moreover, cost sharing varies significantly based on (i) deductibles/high deductible health plans, (ii) co-insurance charging and fixed percentages, (iii) out-of-pocket caps, and (iv) many other models.
Dr. Talwar then highlighted several avenues for providers to assist their patients with affordable prescription drugs. The first she discussed is the Medicare Part D Plan Finder. Prior to 2006, Medicare did not cover any drug costs, so the Part D program was created as a voluntary prescription drug benefit, but run by insurance companies. By 2022, 49 million of 65 million Medicare patients were enrolled in Part D plans. Within Medicare Part D, over 25 different plans are available with consistent premiums ($328/month in 2023), but deductible and co-insurance varies leading to variation in out-of-pocket prescription costs. For example, for abiraterone, there was up to $10,000 variation between two different 2022 plans, and for mirabegron, one year of treatment varies between $1,330 to $3,090 in 2024. Going to http://www.medicare.gov/plan-compare patients can find the following prompts/displays:
Dr. Talwar concludes that the Medicare Part D Plan Finder is a resource for Medicare patients that allows them to review insurance benefits before renewing plans. Also, it provides transparency regarding prescription costs and annual estimates allowing for proactive financial planning.
Secondly, Dr. Talwar discussed the Mark Cuban Cost Plus Drug Company (www.costplusdrugs.com), which is a direct-to-consumer, online, mail delivery pharmacy that does not accept insurance. The price for drugs is equal to the manufacturing cost + 15% markup + 3% pharmacy cost + a $5 shipping fee. This program is different in that it is transparent, has consistent pricing by removing insurance, has pharmacy benefit managers, and also has rebates. This is a good solution for patients with high cost-sharing plans on oral prescription drugs, offering 30-, 60-, and 90-day prescriptions. Providers can send prescriptions directly to the Mark Cuban Cost Plus Drug Company via electronic medical records, with delivery taking 5-7 business days. Of note, this is not a good option for acute issues, such as a urinary tract infection, but can provide low-cost access to quality of life improving medications such as for lower urinary tract symptoms, erectile dysfunction, or chronic conditions.
Work from Dr. Talwar’s group demonstrates significant savings for our patients:1-2
- $1.29 billion in taxpayer savings for urological drugs prescribed within Medicare
- Up to $2 billion in taxpayer savings for Medicare beneficiaries on oral cancer therapy
In her group’s Journal of Urology article, they compared three direct-to-consumer pharmacies to the Mark Cuban Cost Plus Drug Company for an annual supply of tadalafil [1], with the following costs:
- Direct-to-consumer pharmacy #1: $1,500 (9 mg, 28/mo, $4.46/pill)
- Direct-to-consumer pharmacy #2: $1,140 (20 mg, 10/mo, $9.50/pill)
- Direct-to-consumer pharmacy #3: $5,220 (20 mg, 10/mo, $44.50/pill)
Schloegel and colleagues recently assessed the potential urologic prescription drug savings with the Mark Cuban Cost Plus Drug Company.3 They found that a 90 day treatment via the Mark Cuban Cost Plus Drug Company led to savings for 9 of 12 drugs, purchases outside of health insurance:
Additionally, the Mark Cuban Cost Plus Drug Company conferred a cost savings for 5 of 12 drugs even compared to those utilizing an insurance benefit. There were significant variations noted, thus underscoring the benefit of pharmacy shopping.
Next, Dr. Talwar discussed patients using the Amazon pharmacy (www.amazon.pharmacy.com). This was launched in November 2020 and requires an Amazon Prime membership for discounted offers (and 2 day Prime delivery versus standard 4-5 day shipping). There is no acceptance of insurance and it does have a cash-pay comparison tool. Additionally, the RxPass is $5/month, and refills common generic medications at no additional cost, with no proof of insurance or prescription needed. Amazon pharmacy has partnered with PillPack for organizational packaging of prescriptions by date and time and offers faster shipping than the Mark Cuban Cost Plus Drug Company. Dr. Talwar highlighted that the PillPack + RxPass is helpful for patients with multiple chronic conditions requiring daily medications.
Lalani and colleagues recently performed a cross-sectional analysis of five direct-to-consumer pharmacies assessing availability and cost of expensive and common generic prescription drugs.4 The expensive drugs were defined as the 100 generic drugs with the highest cost-per-patient and the common drugs were defined as the 50 generic drugs with the highest number of patients. Among expensive drugs, 80% were available at one or more direct-to-consumer pharmacy, which was 98% for common drugs. For expensive drugs, 47% had the lowest cost at Amazon, 26% at Mark Cuban Cost Plus Drug Company, 14% at Health Warehouse, and 13% at Costco. For common drugs, 31% had the lowest cost at Costco, 27% at Amazon, 20% at Walmart, 12% at Health Warehouse, and 10% at Mark Cuban Cost Plus Drug Company
The following figure highlights the frequency of the lowest cost generic drugs available by pharmacy:
Finally, Dr. Talwar discussed the option of GoodRx for prescription medications (www.goodrx.com). GoodRx was founded in 2011 by former Facebook engineers. It is free to use and compares the generic/brand prescription drug prices at local pharmacies and cash-pay versus co-pay. Additionally, GoodRx provides patients with coupons to present for discounts, which are only valid at specific locations, over specific time periods. The interface for GoodRx is as follows:
GoodRx allows patients to receive discounts on in-person prescription pick-ups and is good for immediate and acute treatment needs (ie. urinary tract infection, pain, etc). In Provider Mode, it allows prescribers to compare local pharmacy out-of-pocket costs for medications and can be used as a decision tool:
For additional resources, Dr. Talwar discussed the integrated electronic medical record real time benefit tools at point-of-prescribing. Importantly, in 2021, CMS mandated that all MPD Plan sponsors incorporate real time benefit checks into the electronic medical record software, but implementation has to date been limited.
Dr. Talwar concluded her presentation discussing online tools to decrease out-of-pocket prescription costs for our urology patients by highlighting that “Online Tools to Decrease Out-of-Pocket Prescription Costs for Patients: A Practical Guide for Urologists” has been accepted for publication to Urology Practice:
Presented by: Ruchika Talwar, MD, Vanderbilt University, Nashville, TN
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 Southeastern Section of the American Urological Association (SESAUA) Annual Meeting, Austin, TX, Wed, Mar 20 – Sat, Mar 23, 2024.
References:
- Cortese BD, Chang SS, Talwar R. Urologic Drug Price Stewardship: Potential Cost Savings Based on the Mark Cuban Cost Plus Drug Company Model. J Urol. 2023 Feb;209(2):309-311.
- Cortese BD, Dusetzina SB, Luckenbaugh AN, et al. Projected Savings for Generic Oncology Drugs Purchased via Mark Cuban Drug Company Versus Medicare. J Clin Oncol. 2023 Oct 10;41(29):4664-4668.
- Schloegel V, Harris L, Harris A, et al. Evaluation of Potential Urologic Prescription Drug Savings with Mark Cuban Cost Plus Drug Company. Urol Pract. 2024 Mar;11(2):276-282.
- Lalani HS, Tessema FA, Kesselheim AS, et al. Availability and Cost of Expensive and Common Generic Prescription Drugs: A Cross-sectional Analysis of Direct-to-Consumer Pharmacies. J Gen Intern Med. 2024 Feb 6 [Epub ahead of print].