Addressing Cost-Related Nonadherence: Price Transparency Supports Provider, Patient Decision-Making

Colin Banas, MD, MHA, chief medical officer, DrFirst, reviews survey findings which suggest a significant portion of patients abandon prescriptions due to cost, and shares how price transparency tools can inform and improve prescribing decisions at the point of care.

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I’m Colin Banas. I'm an internal medicine physician and hospitalist. I'm the chief medical officer for DrFirst.

Can you tell us about DrFirst’s survey on medication adherence? What were the key findings, and did any of them surprise you?

We surveyed 200 adults online, a good mix across all ages and, of course, equal parts male and female. We asked respondents about adherence and their experience with medication, picking up medications, and cost. We did a similar survey probably 4 years ago. We wanted to repeat to see if there were any trends and understand the state of the industry now. 

Unfortunately, we found a lot of the same things that we saw the last time we did this survey. Patients are still having a really hard time with affording their medications, so much so that half of them admitted to not picking up a medication that was prescribed to them simply because of cost. Fortunately, there are things that we can do to improve upon that. We like to do these surveys to get a pulse of the industry as it relates to our solutions at DrFirst.

How do disruptions to adherence impact patients and the health care system more generally?

One of the leading causes of readmissions, at a minimum, is medication nonadherence. If half of your patients are not picking up medications, you can follow that downstream. Those are some of the patients that end up coming back to your emergency department or getting readmitted into the hospital. 

As we shift toward value-based care, this not only has tremendous impacts, of course, on patient outcomes, but it also impacts providers and health systems. These are the sorts of things that hospitals and providers are getting graded on in a public forum. So anything we can do to improve adherence is going to have tremendous impact not only on patient outcomes but also on some of these outward-facing metrics that providers and hospitals are dealing with now.

How can providers and/or payers pivot to alleviate cost-related nonadherence?

One of the great things that's evolved in the last decade, but really picked up momentum in the last 3 to 4 years, is something known as price transparency at the point of prescribing. The idea is pretty simple. As a prescriber, at the point of making a prescribing decision, I can see in real time what your copay as a patient is going to be. Are there alternative drugs that may fit into the formulary or be even more cost-effective for you? I am able to make those decisions and swaps in real time. 

The great thing is, if I have a patient in front of me, we can have a conversation about it. I think in the past, it was a lot of what I would call fire and forget. I'd write you a prescription, you go out the door, and I really have no visibility into A) how much that was going to cost you, nor did you know what it was going to cost you until you showed up at the pharmacy; and B) whether you actually picked the medication up. It may not be until 6 months later when I have you in for a follow up and you say, "Oh, I actually never picked that up. It was too expensive." 

There is technology that can address this. There's price transparency for the providers to see this information. One of the things we've pioneered is also being able to show these sorts of things to patients in an asynchronous manner over a cell phone with an app-like experience.

Where do you see the future of these challenges headed?

We need greater coverage. We need better penetration of these technology solutions. I think the momentum is getting there, it's just not ubiquitous yet. Whether it's price transparency at the point of making the prescribing decision or downstream to the patient, the more you can empower both a provider and a patient with information to make care decisions, the better the outcomes are going to be. It's all about having the right data at the right time to foster a conversation. 

I think being able to have these conversations in real time also builds trust between the patient and the provider. It lifts the curtain on something that's been a black box for patients for as long as I can remember being a provider. I'm pretty excited about it. I just think we need to get the momentum train moving.

Is there anything else you would like to add?

We're entering an exciting era in patient engagement. We’re seeing regulations allowing patients to have more data in the manner that they want it. If you think of things like the 21st Century Cures Act or information blocking, you're starting to see patient empowerment. I think that's really exciting. It goes back to my comment before about lifting back the curtain and revealing things that previously were a black box. 

Those experiences that you as a consumer are used to—whether it's in shopping, aviation, banking—those are finally starting to trickle into health care. That's a really exciting thing, meeting the patient where they need to be met in the manner they prefer.

This transcript has been edited for clarity.