Severe impact of dysfunctional drug discount system on patient health
More than 66% of Americans take prescription medications, many of them in older adults or people with chronic diseases such as diabetes, high blood pressure, or high cholesterol. However, 9 million adults do not take prescription drugs, take fewer drugs, or delay recovery due to sharply high drug prices. If affordable medications are not available, patients’ health is declining and the health care system is paying.
Over the past two decades, the prevalence of chronic diseases in the United States has soared 70 to 8 million people every five years, costing more than $1 trillion per year. The incidence of type 2 diabetes has increased by nearly 20% over the past decade, while deaths due to chronic kidney disease have increased by 50%. Chronic diseases are on the rise, and the current healthcare system is not ready enough to answer the growing population of patients with one or more chronic high-point disease states.
Drug Discount Programs, including drug discount programs that nearly half of the U.S. hospitals are participating in, are designed to allow hospitals that offer a large number of poor, uninsured or insured to buy drugs at discounted prices. Although they intend to help patients with medication, the current system is inefficient and vulnerable to abuse, with little benefit to patients. With direct negative impacts on patient health, the system needs to be reformed to make medicines accessible and affordable to all.
Problems with the current drug discount system
The current drug discount system is so disconnected, inefficient, and savings are rarely passed to patients. Due to the lack of a centralized database or reporting system, it is difficult for hospitals to track and manage discounts or ensure compliance across multiple complex plans. Especially in smaller coverage entities (CES), maintaining compliance can be burdensome, resulting in loss or lack of time and resources to help patients see more savings.
On the other hand, for drug manufacturers, the lack of transparent data sharing has allowed them to obtain the necessary decision-making information to plan for future and to properly serve patients. The lack of transparency also extends to patients. When patients enter 340B hospitals, they rarely know the extent of the discount price they should receive. Since this information has not been tracked or disclosed to patients, savings are often redistributed to hospitals and their suppliers.
As a result, patients do not benefit from the deserving discounted costs promised by these programs, which reduce compliance with necessary medications and treatments, which may lead to worsening conditions and outcomes for vulnerable groups.
Direct impact on patient health
In short, when patients do not take medication, their health worsens and inadvertently loses the loss of the patient and the entire health system, which ultimately adds more costs. For example, one in six of the 2 million American adults with asthma cannot afford their medication. 18% of asthma patients said high drug costs caused them to skip or delay treatment. Skipping medications increases the risk of adverse events such as asthma attacks, which increases the chance of asthma-related emergency room visits by 60%. Not only does this affect the overall health of patients, but avoidable hospital visits cost the health system billions of dollars a year.
Even for these systems, the system is helpful and the results are short. For 98.9% of adults over 65 who are eligible for Medicare coverage, designed to benefit from the drug discount system, 4% simply cannot afford their prescription. 3% skip doses, delay filling prescriptions or taking doses that are smaller than those prescribed for cost reduction. Heart disease mainly affects older people, with 82% of whom die from people over 65 years of age, a major cause of death in the United States, and one in eight people with the disease cannot afford their medication.
Overall, when patients are unable or unable to manage their condition by taking medications prescribed, health conditions worsen, further increasing the burden on patients and the health care system. For example, diabetes is a chronic metabolic disease that is usually treated with oral or injectable drugs. If left untreated, it can develop into more serious and expensive conditions such as heart disease, kidney disease, and even nerve damage that can lead to amputation.
Reimagine a more equitable system
The industry as a whole needs a transparent way to track discounts, maintain active compliance and report discount programs to utilize if it wants to provide patients with benefits and savings promised by drug discount programs. Technology and data sharing capabilities can help organizations minimize human errors and ensure patients get affordable medications without excessive and time-consuming paperwork and record keeping. Technology prevents duplicate discounts, preventing manufacturers from providing the best benefits for patients.
The current drug discount system fails vulnerable patients – designed to help patients. Despite full intentions, the savings from these plans are expected to be rarely to patients. With limited options, uninsured or underinsured patients cannot effectively manage their condition, thereby increasing complications and increasing financial stress on them and the healthcare system. The system urgently needs reforms to improve the health and well-being of the country.
Photo: Taraj, Getty Images
Kenny Cole of PharmD is Senior Director of Value Delivery at Kalderos, where he provides strategic leadership and advises innovative drug pricing solutions that enable entities to work transparently with drug manufacturers. Kenny is an excellent pharmacist with over 20 years of experience in the 340B program. Kenny works with patients, manufacturers and covered entities to understand the needs of each stakeholder and serves as a primary interface between policy and government affairs, law, compliance, commercialization, and strategy and innovation.
Kenny was at Merck & Co before serving as Kalderos. He serves as Deputy Director of Marketing Visit and Head of Strategy at 340B and serves as Director of Policy and Compliance Support at Apexus. Kenny is a registered pharmacist and received his PhD in Pharmacy from the Texas Tech Center for Health Sciences.
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