Over the past 15 years in dermatology, one thing I have seen is an exponential rise in the cost of medications. Even when viewed from within the industry, the answer to the question “Why?” is frustrating and complex. It is not just new, cutting edge medications that are increasing. The cost of generic medications that are decades old have risen from $4 generics to often hundreds of dollars. Insurance companies want to keep premiums down, so are incentivized to limit access to more expensive medications. This has made it very challenging for medical providers to balance prescribing the most appropriate medication for our patients while balancing the cost of care.
Rebate Cards and Preferred Specialty Pharmacies
Branded drug manufacturers have come up with many programs that allow them to keep the cost of their medications high while at the same time minimizing the out of pocket cost to patients. The 2 most common programs are the manufacturer rebate card and the preferred specialty pharmacy. Rebate cards are used by pharmacies after the patient’s insurance has dictated what the patient’s out of pocket cost will be for a medication, to further reduce that cost by a predetermined dollar amount. This was especially helpful for patients whose copays were based on a tier system but often did little to benefit patients on a high deductible plan.
Specialty Mail Order Pharmacies
A recent trend has been the use of specialty, mail order pharmacies. Drug manufacturers may have agreements with specific pharmacies to dispense their medications with a cap on the maximum cost that a patient will have to pay. These types of agreements offer broader cost protection for more types of insurance plans, but can sometime be more inconvenient for patients.
Quality and Cost: A Fight for Balance
These are the factors that we are trying to balance every time we write a prescription. Foremost, we want to provide the absolute best medication for a patient’s condition, but we want that medication to come at a reasonable cost. Unfortunately, current electronic medical software does not allow the provider to know what medication will be covered by insurance and what the cost of that will be. We have to call on experience when deciding whether to prescribe a generic medication with no assistance, a branded medication with a rebate associated with it, or utilize a mail order pharmacy. It is important for patients to know we are not financially incentivized to use any of those prescription options. We just want to find the best deal for our patients. So next time you receive a prescription from your doctor, I hope this explains a little about the thought that goes into each decision.