When your patients can’t afford their medications

When patients indicate they cannot afford the medications you have prescribed for them, do you know what options are available to explore? Often prescribers may be quick to ask about compassionate programs or free supplies that are available to explore, but they are rarely the solution to a permanent problem.

One simple thing to do is to modify how the prescription is written. Below is an example of how changing the way the prescription is written can impact on total cost for the patient.

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Here are five simple things to consider for your patients who may have challenges affording their medications:

  1. Consider cheaper generic alternatives
  2. Consider writing a prescription for a larger quantity
  3. Consider shopping for lower dispensing fees
  4. Consider writing a higher strength (for some medications) if different strength costs the same price and the tablet can be halved for administration (e.g. citalopram)
  5. Consider deprescribing if not indicated or necessary anymore

Recently, the drug prices of many generic medications in Ontario have been reduced. Here’s a document listing all the new prices.

If your patient is struggling financially and you would like to prescribe the cheapest option, here’s my quick list for some common medication categories:

  • ACE-Inhibitor: Ramipril
  • Angiotension II Receptor Blocker: Telmisartan or Candesartan
  • Statin: Rosuvastatin
  • Beta Blocker: Bisoprolol
  • Proton Pump Inhibitor: Rabeprazole
  • Diabetes: Metformin, Gliclazide MR, NPH (insulin)
  • Bisphosphonate: Alendronate 70mg
  • SSRI (Selective Serotonin Reuptake Inhibitor): Citalopram
  • LAMA (Long Acting Muscarinic Antagonist): all very similar but Spiriva Respimat utilizes the most advanced technology for optimal drug delivery
  • ICS (Inhaled Corticosteroid): QVAR, Pulmicort

If the patient requires assistance with their medication costs, here are some options to consider based on age:

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I hope you find this post helpful. Do you have other suggestions to help patients who are struggling with medication costs?

 

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Published by

drugopinions

My name is Cynthia Leung and I am a practicing pharmacist in Kingston Ontario, Canada. This blog is for me to share my ideas, opinions and perspectives on how medications are used in our health care system. Note that these posts are my own opinions and do not represent the opinions of my current or former employers and / or organizations that I may belong to. Any possible case scenarios described in my posts would be modified to maintain patient confidentiality. This blog is not a platform for professional advise for patients or health care providers and the content is not meant to support any clinical decisions or replace professional opinions. Also the images are either taken or created by the author, or adapted with permission. I hope you will enjoy reading my posts!

5 thoughts on “When your patients can’t afford their medications”

  1. Samples sometimes help, but they are usually the newest drug with later downstream costs. Some success with some companies with compassionate supply. Some prescription drugs now are OTC eg nasal sprays.
    Knowing what a drug costs is helpful and the CPA App RxTx has the average cost for each drug.

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    1. Agree samples are great for bridging coverage or trying out a medication before committing to it financially. But there is often a push for new medications with samples. When patient runs out of samples, are they then forced to pay for the medication? In some way, I find it unethical to give samples to a patient especially when we know the patient may not be able to afford it in a long run. Thanks for sharing your tips about the CPA App RxTx.

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  2. We’re struggling with this in the USA where insurance doesn’t cover much, so out of pockets are ridiculously high.

    My endo recently said she was going to prescribe Glucophage and instead wrote an RX for Glumetza at $6,000 a month.

    3 email fights later, as the second option was $2,000 a month, was to stay on Metformin. It’s so frustrating for the doc’s to suggest stuff that even Rockefeller couldn’t afford. I would love it if the USA had options like you’re displaying for Canada.

    Thanks, as always, for your perspective.

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    1. I don’t think we are far off. I know some medications are cheaper in Canada but we are overall facing the same problem – with the rising drug costs, it is not sustainable whether through public or private payors.

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  3. Great tips!

    In my opinion, all pharmacies should have same dispensing fee. For each prescription, pharmacist follows standards of practice (professional duty). Dispensing fee is a professional fee for every prescription and shouldn’t be a subject of discount in this competitive pharmacy environment.

    Let it be a free market where supply and demand decides the price. Government shouldn’t interfere in retail level finance. If they want to subsidise, then they have to be fair. OPA should negotiate our fees with them. They should be standard all across the board.

    Thank you.

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