In this process of shared decision making, clinicians need to explain not only clinical indictors but also efficacy and side effects, as well as cost and accessibility, she added.
"However, most providers don't have access to patient pay information, and the patient is often unaware of the out-of-pocket costs until they arrive at the pharmacy," she said.
"Luckily, there are tools available that enable prescribers to view patient cost-share information while the patient is in the office," Gill said. "RxBenefit Clarity, for example, is a tool that delivers the most accurate patient pay and real-time benefit information in the prescribing workflow, which can help prescribers have more informed conversations with their patients that can help drive adherence."
It is also helpful to outline the process of drug approval and addition to Medicare formularies so that patients understand that decisions about coverage are made not by their doctors but by the government agency. And while it is difficult to predict when (or if) a drug will be added to the formulary, patients who are likely to use a medication long-term may be reassured by the prospect that high out-of-pocket costs could be a temporary obstacle if a drug is added to the Medicare formulary within a matter of months.
The discussion also should explore include alternative medications to achieving treatment goals if no options exist to lower the cost of a drug and the patient is unable or unwilling to pay the full amount.
"Our goal is to take care of the patient's vision regardless of the price," Dr. Teymoorian said. "The price is very important, because it comes into play, but we shouldn't eliminate an option that we think is right for the patient strictly based on price. We need to at least present alternatives to the patient and let them decide what's the best option."
Savak "Sev" Teymoorian, MD, MBA
E: [email protected]
Dr. Teymoorian is a speaker and consultant for Aerie Pharmaceuticals and Bausch + Lomb and conducts research for both companies.
Miranda Gill, MSN, RN, NEA-BC
E: [email protected]
Gill did not report any disclosures.