Patient Adherence Goes Up as Out-of-Pocket Costs Go Down

The sky-rocketing cost of healthcare certainly isn’t breaking news. There is, however, an unfortunate trend related to these rising fees. As costs increasingly shift from payers onto the patients themselves – through greater out-of-pocket costs – finances for some patients hit a threshold which impacts adherence. In other words, some patients are simply getting priced out of treatment.

In a new study shared at the 26th Annual Academy of Managed Care Pharmacy (AMCP) Meeting in Tampa, Florida last week, Prime Therapeutics (a pharmacy benefits management company) showed some eye-opening and disheartening findings. As out-of-pocket costs rise above a threshold of $250 for an individual patient, that patient becomes less likely to start prescribed treatment with a specialty medication. Conversely, out-of-pocket costs less than $250 for a patient make starting treatment more probable.

Digging deeper into the data of this study reveals that, for one in ten patients starting a new therapy with a biologic anti-inflammatory medication to treat rheumatoid arthritis or medications for multiple sclerosis, out-of-pocket costs can exceed $1,000. As costs pass the $250 threshold, start rates decline, with abandonment soaring skyward as patient costs approach the $2,000 mark.

Relief is in reach, though. Patient assistance, through grants from patient assistance foundations and co-pay cards, can make a huge difference for patients with massive out-of-pocket costs. Of course, a patient who doesn’t even start therapy cannot be adherent and will not be able to have an optimal treatment outcome. As such, BioPlus Specialty Pharmacy continues to commit resources to our Patient Assistance Program. In the last year, our program connected patients with $7.2 million in patient assistance programs and co-pay assistance; serving as a bridge for patients to start treatment despite mammoth out-of-pocket expenses.

Stephen C Vogt, PharmD
President and CEO
BioPlus SP


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Williams B. Prime Therapeutics study finds patients more likely to start specialty medications when out-of-pocket costs are under $250. PRNewswire April 2, 2014.

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