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Overview

Medicine is an important component of many patients' treatment regimens. Unfortunately, patients sometimes try to save money by reducing the amount of medicine they take or not taking their medicine at all. Helping patients reduce the cost of their medicine may make them more likely to take it and may help them afford other things important to their health.

Action

Consider whether patients can take fewer or less expensive medicines.

• Deprescribe medicines that patients no longer need or are causing more harms than benefits. Use to reduce doses or discontinue medicines safely. 
• Switch drugs to generics, over-the-counter medicines, or less expensive brands when safe and effective.
• Prescribe 90 days' worth of medicine to reduce copays, if appropriate. 
• Prescribe medicines with low or no copays, which will depend on the patient’s insurance coverage.

Assess patients' ability to pay for their medicines.

• Ask patients if they have difficulty getting their medicines. Be sensitive to potential embarrassment. For example, you can ask one of these questions:
  • "Have you ever been unable to get medicine when you needed it?"
  • "Have you ever delayed taking medicine or taken less to make it last longer?"
  • "Is the cost of any of your medicines a burden for you?"
• Document patients' responses in a consistent place in the medical record.
• Let patients know you want to help. Emphasize how important it is for them to take their medicines. Tool 23: Talk About Costs provides more information about having these conversations. Tool 16: Help Patients Take Medicine Correctly has suggestions on what to do if the barriers to getting medicine are not financial.

Help patients find financial assistance or less expensive medicines.

• Connect patients with medicine assistance programs. Resources for Financial Assistance for Medicine provides links to services that help patients reduce their medicine expenses. Help patients find a program that fits their needs and help them apply.
• Help patients shop around for the best price. Prices for medicines can vary greatly. Mail-order pharmacies can sometimes provide chronic disease medicines at a lower cost, and they eliminate the need to pick up medicines from a pharmacy. Some pharmacies offer reduced prices for specific medicines for eligible people or general discount cards. Educate patients that they should give their medicine list to all the pharmacies they use, so pharmacies can identify harmful drug interactions and other safety problems.
• Make sure Medicare patients have . People can get help enrolling in Part D from counselors or the .
• Document what assistance you gave them, schedule a followup to see if they need further help, and document the results of the followup.

Track Your Progress

Track over time how many patients you identified as needing assistance paying for their medicines, and note the services the practice provided.

Before implementing this tool, randomly select at least 20 medical records of patients who regularly take medicines and were seen in the last week. Calculate the percentage of patients whose ability to pay for medicine was assessed and the percentage of those in need who received assistance. Check again in 2, 6, and 12 months.

Choose a sample of patients whom you have referred to insurance or medicine assistance programs. Check whether there was followup within 1 month, and find out how many have obtained insurance or other help paying for medicine.

Before implementing this tool and then again 2, 6, and 12 months after implementation, collect patient feedback on a selection of questions about this tool from the Health Literacy Patient Feedback Questions.

Refer to Tool 2: Assess Organizational Health Literacy and Create an Improvement Plan to learn how to use data in the improvement process.