When Dr. Gary Konkol writes a prescription at Allina Health Woodbury Clinic, the electronic medical record pops up with messages about drug interactions and, depending on the patient’s insurance and pharmacy, how much it is going to cost.
Allina’s prescription pricing tool allows doctors to compare prices and explore more affordable alternatives. It is one way medical providers are addressing rising drug prices and the prospect of patients abandoning prescriptions at the pharmacy due to the inability to pay.
“I think it has been a great enhancement so that people don’t get sticker shock at the pharmacy,” Konkol said of the feature that was added to Allina’s medical record system this past year.
The family medicine physician said he uses the pricing tool at least a couple times a day. Though it is relatively new, Konkol said his patients typically are not surprised when he tells them how much a prescription will cost — it seems like something that just makes sense.
The system is not perfect, he added, as drug prices do not show up for all patients because of out-of-date formularies. A formulary is a list of name-brand and generic drugs covered under a prescription drug plan.
Spending on prescription drugs in the U.S. has steadily increased over the past decade, according to a 2018 fact sheet by the Pew Charitable Trusts’ drug spending research initiative. One projection has drug spending reaching $584 billion in 2020, up from $356 billion in 2010.
A Kaiser Family Foundation poll in February found that 24% of U.S. adults and 23% of seniors say it is difficult for them to afford their prescriptions.
Konkol said he has seen firsthand what can happen when a patient is unable to afford a prescription. One of his longtime patients had high blood pressure despite multiple medications to get it under control.
“I did all these tests and looked to see if there was some unusual condition contributing to this, and there wasn’t,” he said.
Then the patient had a stroke. Konkol said he later learned the patient, who has limited funds and not much medical insurance, was not taking the medication as prescribed.
“Because of the money and because of embarrassment,” Konkol said. “It just really shook me up.”
Minnesota lawmakers have taken steps to tackle drug costs, including outlawing “gag clauses” that prevented pharmacists from telling consumers about cheaper alternatives to drug insurance plans.
Meanwhile the Wisconsin Pharmacy Patient Protection Coalition was formed earlier this month to support companion bills in the Senate and Assembly that would eliminate “gag clauses” in the state and put greater regulations on Pharmacy Benefit Managers or PBMs, the third-party managers of prescription drug programs and formularies.
“PBMs have done everything possible to keep their actions secret as they pocket savings meant for patients,” said Rob Gundermann, chair of the Wisconsin Pharmacy Patient Protection Coalition, in a news release. “These middlemen between insurers and pharmaceutical companies were supposed to reduce patient costs and ensure quality medication use, but some got greedy in the process.”
September also marks the one-year anniversary of Civica Rx, a not-for-profit generic drug company founded to increase competition in the market and improve availability and affordability of generic medications. Mayo Clinic is among the company’s governing organizations.
Civica Rx plans to make its first deliveries of the antibiotic Vancomycin this fall.