The Cost of Care

Published on 25 August 2015

The cost took her by surprise. Janelle Mann, Pharm.D., BCOP, was checking on the cash price of a medication that was about to be recommended for treatment of a patient with cancer. Mann, assistant professor of pharmacy practice at St. Louis College of Pharmacy, knew very few people who could afford a $9,000 a month treatment.

“I’ve seen patients do anything and everything to afford their care,” Mann says. Some patients have even taken out a second mortgage and gone into deep debt.

The expensive medication was recommended and prescribed for treatment of the patient’s cancer based on how the medication would attack the cancer. In some cases, Mann explains, the patient’s prescription plan picks up some of the cost but every insurance plan is different.

“For this patient, their Medicare prescription plan was approaching the ‘donut hole’ which would require 100 percent out of pocket payment,” Mann says. “Once they were out of the hole, she would be in the catastrophic phase of her plan, which would require her to pay a percentage of the drug cost.”

For that $9,000 medication, even paying 5 percent would be $450 a month. Mann says she now regularly checks on the price of medication before she and her interprofessional team of physicians, nurses, and social workers talk with the patient about his diagnosis and treatment options.

“We have to have an honest discussion with the patient about whether the treatment is affordable, along with determining if the therapy is appropriate and has manageable side effects,” Mann says.

If the patient cannot afford the preferred treatment option, Mann and her team work to find other treatment plans or drug assistance programs.

'Financial Toxicity'

Laura Challen, Pharm.D., MBA, BCPS, BCACP, assistant professor of pharmacy practice at St. Louis College of Pharmacy, and ambulatory care pharmacist at a St. Louis hospital, regularly has two medication pricing options for patients. Manufacturers sometimes offer patient assistance programs (PAPs), which give patients free brand name medication. Challen’s clinic also receives federal 340B grant funding to offer heavily discounted prescriptions.

“I tailor my treatment plans according to what my patients can afford, and what is a good long-term solution,” she says. “I have to find solutions for my patients that are sustainable.”

Both she and Mann say they’re now expanding treatment plan recommendations to include financial information about the medication.

“Financial toxicity is something we’re now having to consider,” Mann says. “It totally changes how individuals, even those in health care positions, think about treatment options.”

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