Generic Alternative Allows Patient to Remain Adherent to Treatment at Significant Cost Savings

BACKGROUND

Often, patients with chronic medical conditions are faced with prescription medication costs that make treatment financially out of reach. After hospitalization, patients are often discharged with new medications. Sometimes, these medications are covered under current insurance plans, but if not, the out-of-pocket cost can lead patients to forego treatment, which can be dangerous or deadly. Lower cost generic medications can offset the expense, while still offering the level of treatment a patient needs.

CHALLENGE

A patient experiencing pancreatic enzyme deficiency was prescribed a brand name medication at a cost of $700 per week. The drug was deemed essential to the patient’s recovery and management of the chronic disease, but unfortunately was not covered under the patient’s insurance plan. The patient was faced with a difficult decision: pay rent, or purchase medication. With the patient’s limited budget, it was a decision between health and home. Adherence, in this case, was simply not feasible.

SOLUTION

APC clinicians met one-on-one with the patient and performed a comprehensive medication reconciliation. Through the reconciliation process, the APC pharmacist discovered a generic alternative that was covered under insurance. With copay, the generic alternative cost the patient $1 per week as opposed to $700 per week for the name-brand medication. The alternative was only discovered through the reconciliation process. Without the insight and expertise of the APC pharmacist, the patient would not have been presented with a viable, cost-effective treatment.

Case Study Summary:

  • Patient released from hospital with new prescription
  • Brand-name medication not covered by insurance
  • Facing out-of-pocket cost of $700 per week
  • Adherence not feasible
  • APC performed medication reconciliation
  • Identified cost-effective generic medications
  • Reduced out-of-pocket cost from $700 to $1 per week
  • Patient still received proper medication and dosing

RESULTS

As a result of APC’s exceptional reconciliation, the patient was able to save nearly $700 per week in potential out-of-pocket drug costs while still receiving the dosage needed to manage the chronic pancreatic enzyme condition.

Most importantly, the patient was no longer faced with the choice between having medication or a home. APC’s reconciliation process went above and beyond merely taking inventory, to look deeper into the patient’s personal needs. APC helped the patient realize a more complete, and cost-effective way remain healthy at home.