Expensive Out-of-Pocket Costs: The Latest Treatment Side Effect?


High health care costs leading to financial strain should be considered a side effect of treating a disease for some patients, posits Peter Ubel, M.D., Professor at Duke University, and his colleagues in a provocative new article in the New England Journal of Medicine. Most physicians speak openly with patients about a new chemotherapy medication which causes serious side effects before starting that regimen, yet the same doctors probably don’t disclose the “toxicity” of high costs with that theoretical new medicine, he points out.

Many patients experience a significant gap between what their insurance covers and their total health care bill. In some cases, patients can’t start or complete treatment because they are unable to financially bridge that difference. A recent literature review found that, over the past few years, the increase in the patient share of medication costs is negatively impacting patient adherence.

Do patients deserve full disclosure of both physical and financial problems as they weigh the risks and benefits of different treatment plans? Since patient financial responsibilities of treatment (and even diagnostic tests) can “…be “financially toxic,” imposing out-of-pocket costs that may impair patients’ well-being…” physicians should include this as part of the discussion of choosing a treatment plan, says Dr. Ubel; just as medication side effects of various treatments are weighed and debated.

According to data gathered in 2011 by the Centers for Disease Control and Prevention, estimates are that about one-third of families in the United States default on health care payments or struggle to pay medical bills. Additionally, Dr. Ubel cites a few more examples of sky-rocketing out-of-pocket costs:

    • $4,000 per year to manage uncomplicated diabetes
    • $40,000 per year for patients with a myocardial infarction requiring hospitalization
    • $55,250 for women with high-deductible insurance plans being treated for breast cancer 

Including a cost component during clinical decision-making between a patient and physician brings several benefits, notes Dr. Ubel, including:

    1. If there is a viable alternative, a patient can choose a lower cost treatment.
    2. A patient who would be burdened by financial responsibilities can consider a trade-off of a less effective medication for less financial distress.
    3. Patients who better understand upcoming out-of-pocket costs can more quickly seek financial assistance and prevent future financial distress. 

We believe strongly in financial transparency for patients at BioPlus Specialty Pharmacy and we achieve this by reviewing insurance benefits and estimated costs for therapy for each and every patient at BioPlus Specialty Pharmacy.

Additionally, the Patient Foundation Assistance program at BioPlus connects patients in need with various foundation grants and co-pay assistance. By working with patients early in the process, we help them prevent becoming financially overburdened. In fact, last year our program successfully connected BioPlus patients with $5.1 million in foundation grants and co-pay assistance.


What do you think

I’d love to hear your opinion in the comments section below.

Stephen C Vogt, PharmD
President and CEO
BioPlus SP



Eaddy MT, Cook CL, O’Day K, et al. How patient cost-sharing trends affect adherence and outcomes: a literature review. P T 2012 Jan;37(1):45-55.

Ubel PA, Abernethy AP, Zafar SY. Full disclosure: Out-of-pocket costs as side effects. N Engl J Med 2013; 369:1484-1486

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