How Specialty Pharmacies Can Increase Access Through Patient Financing

More than 4 in 10 Americans are concerned that prescription drug costs will lead to bankruptcy or debt.¹ One-third of respondents to the same study said the cost of their prescription medications rose last year.¹

For those living with rare, chronic, or complex diseases who require specialty pharmaceuticals, cost-related concerns can be even greater. Specialty medications are costly, have a more complex benefit structure, and follow strict payer utilization management parameters that complicate patients’ ability to access prescribed therapy.

For these reasons, it’s essential that health care providers across the patient journey demystify the costs of treatment and provide solutions to overcome the financial barriers, helping to ensure patients can access the care and treatments they want and need.

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The Financial Challenges Patients Face

In 2022, Synchrony conducted the Lifetime of Healthcare Costs study and found that respondents underestimate their annual health care expenditures by approximately 400%, reporting they spend $1100 (not including paid premiums) on average annually. In actuality, they spend closer to $5500.²

These unanticipated health care costs are not only surprising for consumers but impact their decisions on care. According to surveys by Kaiser Family Foundation and Cover My Meds, 51% of patients sacrifice medications, 43% sacrifice essentials, and 41% modify treatment plans to compensate for cost-related challenges.^3,4

For patients with complex health care needs who often need costly specialty medications, these financial pressures mount.When it comes to prescription medications, Americans pay higher prices for prescription drugs than any other country in the world, with prescription drug prices in the US more than 2.5 times as high as those in other similar high-income nations. Specialty drugs represented 50% of total drug spending in 2021, and the cost of specialty drugs has continued to grow, totaling $301 billion in 2021, an increase of 43% since 2016.⁴

Patients in need of specialty drugs face additional barriers to care, including coordinating with and paying for reoccurring visits with one or more specialty providers, navigating complex regulations, and overcoming access and administrative barriers. Most specialty medications are dispensed at specialty pharmacies due to handling and monitoring requirements, and they’re often not as readily available to patients. Altogether, specialty drug access challenges can lead to issues with therapy initiation and adherence, impacting patient outcomes.

Overcoming Financial Barriers for Specialized Medicine

Pharmacies have an important role to play in addressing the financial barriers that decrease access to specialty drugs. As complex as our health care system is, it’s critical that pharmacists provide clarity on costs, as well as payment options for patients.

Pharmacy teams can help patients overcome financial barriers by walking through the various options for planning for and paying for their care and medications:

• State programs: Financial assistance programs through the state, available based on patient eligibility
• Employer-sponsored flexible spending accounts (FSA) and health care savings accounts (HSAs): Tax-free savings accounts specifically created to pay for qualified health care expenses, often with employer contributions
• Emergency savings funds specifically for medical costs: Medical expenses are sometimes the costliest emergency expenses. Some third-party financial providers offer high-yield savings accounts and money markets that have no minimum deposit. These are good places to store a medical emergency fund.

Specialty pharmacies can also partner with a third-party financial services provider to offer patients a health and wellness credit card. Through this type of partnership, pharmacies can offer more financial solutions options that meet the needs of patients. Instead of paying for their medications in one lump sum, patients can use their health and wellness credit card to pay for their medications over time and in a way that works within their budgets. Another benefit of a financial services provider is the educational resources available to pharmacy staff and patients that can elucidate the complex world of health care billing.

Providers and pharmacies must ensure their teams understand all the factors that impact a patient’s access to essential specialized and preventive care, whether they be a lack of available information and resources for patients, administrative barriers, or the burden of out-of-pocket costs. With a commitment to improving access to specialized care, we can all work to ensure that patients struggling with rare, chronic, or complex diseases have the resources to access the care they want and need.

References

1. HealthCare.com. 4 in 10 Fear Prescription Drug Spiral into Bankruptcy, Debt: Survey. October 4, 2022. Accessed January 15, 2024. https://www.healthcare.com/prescription-drug-survey-2022-493197

2. Synchrony. Lifetime of Healthcare Costs Research. 2022. Accessed January 15, 2024. https://image.emails.carecredit.com/lib/fe331570756406747d1173/m/2/1a90c56b-55cd-4ba9-ab0f-97907af17049.pdf.

3. Pestaina, K., Montero, A., Lopes, L., Valdes, I., Kirzinger, A., Brodie, M. (2023). KFF survey of consumer experiences with health insurance. https://www.kff.org/private-insurance/poll-finding/kff-survey-of-consumer-experiences-with-health-insurance/

4. Beardsley, J, H. (2022). Cash or bust: why discount cards could be key to medication adherence. https://insights.covermymeds.com/healthcare-technology/prescription-cash-price/cash-or-bust-why-discount-cards-could-be-key-to-medication-adherence