Patient Tipping Point

Patients face a tipping point when it comes to out-of-pocket costs. When patients’ share of health care costs reach a certain threshold, patients are more likely to skip refills of medications or fail to get their prescriptions filled in the first place. Most recently, this was demonstrated in a study of 864 rheumatoid arthritis patients prescribed a biologic disease-modifying antirheumatic drug (DMARD).

It’s important to note that, for rheumatoid arthritis, DMARDs are a mainstay treatment. So patients who “take a pass” on these medications based on cost concerns will not get the necessary treatment for what can be a disabling disease. The researchers uncovered that the rate for patients abandoning their treatment ranged from as low as 1.3% for the group with low out-of-pocket costs but shot up to 32.7% for the group with high out-of-pocket costs for biologic DMARDs. Looking at the numbers another way, the patient group with out-of-pockets costs of $0-$250 experienced a 1.3% nonadherence rate, while the patients at the other end of the spectrum (>$550 out-of-pocket costs) reached 32.7% nonadherence.

Meanwhile, patients who reached their coverage limit for specialty pharmacy (thus, their costs were capped), saw a lower chance of therapy abandonment. Both filling and refilling a prescription experienced similar cost-adherence relationships. In summing up, the researchers noted that the higher a patient’s out-of-pocket costs, the lower the chances of that patient to initiate or refill a biologic DMARD medication for rheumatoid arthritis.

The relationship between adherence and patient outcome is clearly known: non-adherent patients face worse health outcomes and greater disease complications. Assuming that out-of-pocket costs aren’t likely to change for patients, then it’s important to work to reach these patients and improve adherence.

Specialty pharmacies are in a unique position for this goal of upping adherence. At BioPlus Specialty Pharmacy, we work toward this goal with the IRIS (Intelligent Real-time Information System) Insights program. With IRIS Insights, we close the communication loop back to the payer and with pharma based on patient outcomes and adherence data. IRIS Insights readily reveals utilization information and key performance indicators for each disease by showing cure rates, completions rates, complications experienced by patients, costs associated with those complications, adherence measures, and the impact of pharmacy interventions prior to treatment. There is also the important opportunity to connect patients who are challenged by their costs with patient assistance programs.

With IRIS Insights, there is clear and easy access to ongoing patient monitoring and all stakeholders can track the appropriate utilization of medications (in terms of both medication and duration) which leads to better treatment adherence for patients while garnering savings for plans.

Stephen C. Vogt, Pharm.D.
President and CEO
BioPlus Specialty Pharmacy |

Hopson S, Saverno K, Liu LZ, et al. Impact of out-of-pocket costs on prescription fills among new initiators of biologic therapies for rheumatoid arthritis. J Manag Care Spec Pharm 2016;22(2):122-130.

Shaw G. High out-of-pocket costs contribute to adherence declines in RA. Sp Pharm ContFebruary 26, 2016.

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