When Cost Barrier Care: Why Drug Affordability Is the Next Area in Patient Care

Walk into any pharmacy and you’ll see the core contradiction of American health care: a shelf full of life-saving therapy that millions of Americans simply can’t afford. As many as half of patients with chronic diseases are unable to take medication as prescribed, and cost is the main driver. This decision is usually made quietly, invisible from clinicians, and an estimated avoidable healthcare spending each year is estimated to result in an estimated $100,000 in life span and nearly $100 billion.

More than 9 million working-age Americans reported in 2021 that they skip doses, reduce medications or delay supplementation because they can’t afford the prescription. This will certainly cause harm to individual patients; but it also constitutes a medical system. Drug non-compliance involves up to 25% of hospitalizations in the United States each year as well as countless emergency visits – if we address affordability in advance, dire results can be prevented.

For hospitals that are increasingly focusing on value-based care, rising freight costs are more than just a social concern – they are clinical risks. The discharge plan is only as powerful as the patient complies with the plan, which also means the ability to pay for their necessary prescriptions.

Hidden driver for readmission

For example, if a monthly COPAY of $500 per month prevents diabetics from filling out their GLP-1 prescription, it could undo decades of transition to care, follow the work of phone calls and remote monitoring. Patients with low compliance rates are more than 2.5 times more likely to be taken to the hospital within 30 days. However, traditional care strategies rarely have surface affordability barriers until after damage occurs.

Why is the gap? Outside of clinical workflows, drug costs are often considered as pharmacy effects managers (PBMs) or insurer issues. Frontline teams may not know the cash price of drugs, let alone the maze of discount cards, manufacturer coupons, pricing or updated direct consumer options. Patients can browse this complexity by themselves. For clinicians who try to surpass their patients, they often spend hours helping patients gain savings manually through the resources they are isolated. These processes are very inefficient and ultimately navigate the complexity of the patient alone. The results are predictable: sticker impact, skip fillers and worsen health.

Affordability as a communication problem

In essence, drug affordability is a data and communication challenge. Encouragingly, prospective health systems are beginning to embrace this advocacy role as part of their patient care strategies. Some leading healthcare organizations across the country have recently launched a move to proactively support the cost of medications as a standard element of the transition to care. Hospital leaders are increasingly aware that assisting affordable patients is an important part of improving outcomes and controlling costs.

In fact, this means that hospitals are developing beyond the scope of traditional discharge instructions. They are targeting staff, pharmacy teams and technical resources to help patients with insurance, identify lower-cost alternatives, and participate in assistance programs before leaving the hospital.

However, the requirement to implement this support bakes drug affordability best practices directly into patient-oriented interactions, so that access can be provided through conventional communication channels:

1. Real-time pricing intelligence Spread thousands of pharmacies, PBM configuration, co-assist and cash card networks.
2. Personalization These factors are factors in the patient’s insurance status, preferred pharmacy and clinical protocol.
3. Proactive publicity – The patient actually uses the device delivered in simple language.

This is exactly the workflow hospitals have run for appointment reminders, post-dismissal symptom checks and nursing program education. Expanding the same patient-centered communication channel to prescription pricing is a logical next step.

The way forward

Resolving the drug affordability crisis will require decisive patient-centered actions by hospital and health system leaders. The good news is that tools and strategies to make a difference are already available.

By embedding enthusiasm, personalized communication about drug costs into routine care, hospitals can narrow the key gap in nursing continuity. This means seeing drug visits as a core component of patient care; education about their condition or scheduled follow-up appointments. When the hospital has a clear plan for how patients can get prescriptions at an affordable price, it expands the circle of care outside the wall and truly embraces all-patient health.

Urgency cannot be exaggerated. Every day, patients miss the medications for costs and are evident in worsening health and avoidable hospitalization. The health system is in a primary position to break this cycle by acting as an advocate for the financial and physical health of patients. It’s a strategic and compassionate shift: a process in which hospitals can make it a common goal and support rather than assuming that drug adherence is merely a burden to the patient.

Leading health systems focus on providing some key steps for world-class patient care:

1. Make affordability a standard conversation point during discharge and follow-up: Ask patients if costs can hinder their compliance and use ready-made solutions when the answer is yes.
2. Leverage technology and partnerships: Deploy automated outreach to connect patients with cost-saving resources and work with pharmacy services or charitable programs that can expand financial assistance.
3. Measurement and iteration: Track how these interventions affect prescription fill rates, patient satisfaction, and reinitiation rates and use these insights to refine the approach. This is a learning process, but there is a huge room for improvement for both patient health and system sustainability.

Finally, it is crucial to maintain a collaborative and understanding tone in all patient communications about costs. The conversation about money in healthcare can be sensitive; patients need to feel that their provider is an ally, not a judge. When done correctly, simply promoting a universal alternative or copay coupon about low-cost can communicate with patients: “Your health is our top priority and we are here to help you successfully treat.”

This trust and partnership is at the heart of patient care – which is what drives better adherence and outcomes.

Photos: jpldesigns, Getty Images

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