Guest writer

Value for dollars

Pharmacists vital link in care

The July 1st article "Arkansas Works tab put at $300M more" cited the "rising cost of prescription drugs" as the primary reason for the increase in the estimated cost of the program. The average person reading the article might misconstrue that the "rising cost of prescription drugs" implied that the pharmacists and pharmacies are being paid too much for their services.

Nothing could be further from the truth.

Pharmacists' reimbursements for medications have been ratcheted down month after month, year after year, by the benefits middlemen that force take-it-or-leave-it contracts in the prescription drug marketplace. These reductions in reimbursement impact both locally owned pharmacies and large chain pharmacies in the same way. Last fall, one of the nation's largest chain pharmacy retailers even cited a decline in pharmacy reimbursements as a major reason for a decline in their overall earnings.

So this begs the question: What is the cause of the prescription medication price increases if the pharmacists' reimbursements continue to be decreased?

The primary reason for the increase is the pharmaceutical manufacturers of both brand and generic medications constantly raising prices of medications. For example, the cost for the average pharmacy to purchase a vial of Novolog, a popularly prescribed brand-name insulin, has gone up in price from $129 per vial in October 2012 to $247 per vial today (based upon data from the Centers for Medicare and Medicaid Services).

Many generic medications have taken large jumps in price over the same period of time too. The cost for the average pharmacy to purchase 20 doxycycline hyclate 100 mg tablets, a popularly prescribed antibiotic, has gone from $1.20 in October 2012 to $17.20 today.

Specialty medications, such as the newer medications to treat hepatitis C, can cost upwards of $90,000 for a 90-day course of therapy! These specialty medications represent 35 percent of the total dollars spent on prescription medications today, yet they are less than 5 percent of the total prescriptions dispensed.

The second reason for the increase in medication expense is less obvious, but it is a very important consideration. It is medication adherence. Medication adherence is when patients fill and take their medications for chronic illnesses in correct dosages and as prescribed. We want this to happen. For example, as a health-care system we want patients who have diabetes to take their medications as prescribed.

For this reason, when evaluating prescription medication expenditures, you cannot just simply scrutinize the price and ignore the bigger picture. Health-care payers have to look at their expenditures on prescription medications as investments in preventing costlier care down the road. For example, every additional $1 spent on diabetes medications helps save $7 on other services from diabetes-related complications.

Pharmacists, the health-care system's medication experts, are uniquely placed within the system to help with both of these issues of high drug prices and keeping patients adherent to their medication.

First, pharmacists are the only health-care professionals who understand both the therapeutics and economics of prescription medications. This means that health-care payers that are willing to financially incentivize pharmacists to work with doctors and patients to use medications that are clinically effective but more financially affordable can help save money for the entire health-care system.

Additionally, pharmacists are the most accessible health-care professionals. The average Medicaid patient visits their local pharmacist 35 times each year. That is 35 opportunities for face-to-face encounters to encourage, educate and involve the patient in the active management of their health and well-being.

In Arkansas, this face-to-face interaction and appointment-based medication synchronization has dramatically increased medication adherence rates, which we know will save health-care dollars.

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Scott Pace is the executive vice president and CEO of the Arkansas Pharmacists Association. Pace is a pharmacist and attorney who lives in Little Rock.

Editorial on 07/22/2016

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