How Can Pharma Solve the Affordability Puzzle?

Kristina Crockett
Vice President, Product Management
CoverMyMeds

Data, collaboration and technology offer solutions in the ongoing quest for medication affordability. The sooner healthcare stakeholders can confront this critical issue, the more consumers they can help get, and stay, on therapy.

For pharmaceutical companies, affordability strategy comes into play at all the major points along the care continuum, from provider price awareness to interactions at the pharmacy to payer partnerships. It’s a tremendous opportunity for pharma to innovate and solve systemic problems.

To be sure, the chorus calling for making prescriptions affordable is building to a crescendo. More than half of U.S. states are considering or have recently considered bills surrounding patient coupons and cost-sharing. A host of other state-level measures seek to address price transparency, rein in rising prices and enact formal affordability review boards.

At the federal level, the Inflation Reduction Act that became law Aug. 16 included a provision intended to reduce drug prices for Americans on Medicare.

The moves come at a time when consumers are shouldering more of the healthcare cost burden, and they’re more in need of care. Six in 10 American adults have a chronic condition, and four in 10 have two or more such conditions, which require ongoing treatment.

In the meantime, the rise of high-deductible health plans is shifting costs away from employers, disproportionately impacting low-income families. In 2018, out-of-pocket healthcare costs were more than 20% of disposable income for almost half of low-income adults on such plans.

That was, of course, even before inflation rose to historic levels in 2022, further stressing household budgets. Rising costs also are putting pressure on the healthcare sector, with the likelihood those hikes will be passed on to consumers at some point.

These factors are a recipe for sicker patients.

For medication specifically, the 2022 CoverMyMeds Medication Access Report found 79% of patients went to pick up a prescription and learned it cost more than they expected. Sometimes, sticker shock leads to prescription abandonment. For more than half of patients surveyed by CoverMyMeds in 2021, the stress of living paycheck to paycheck resulted in them forgoing treatment at some point to pay for basic needs.

What pharma can do

So how can pharma apply its innovative mindset to the affordability puzzle? Technology and collaboration across healthcare stakeholders holds the potential to create newfound price transparency as patients talk to their doctors about their new prescriptions.

Knowing what a medication might cost, whether it’s likely to face prior authorization (PA) and what copay support is available can help providers and consumers make informed choices during those conversations.

The use of electronic prior authorization can mean patients get on treatment faster—13.2 days sooner than when their providers use manual methods of gaining PA, according to the 2022 Medication Access Report.

At the pharmacy, copay and patient assistance programs can serve as the bridge getting consumers on treatment they might not be able to afford otherwise. The affordability discussion is commonly happening at this point in the patient journey — 44% of patients in 2021 talked to their pharmacist about ways to afford their prescriptions.

For patients facing a diagnosis of cancer or some autoimmune diseases, the treatments will be more complex and often more costly. Pharma can change outcomes here by connecting patients with claims and administrative support for specialty therapies.

Data transparency between pharma and payers can unlock understanding about what treatments are most effective, saving stakeholders across the system time and resources. More importantly, this collaboration could lead to improved public health.

These are just a few ways pharmaceutical companies can help make medications more accessible for patients.

For a roadmap to how stakeholders can make prescriptions affordable for patients, access the report Overcoming Medication Affordability Challenges with Patient-Centered Solutions.