Shifting Focus from Medication Costs to Medication Value
When it comes to medication costs, we’re not asking the right questions — or at least, we’re not asking them loudly enough.
Let me explain. Each year, we see medication costs rise. The American Journal of Health-System Pharmacy reported U.S. spending on prescription medications to be $722 billion in 2023, a one-year increase of 14% and a five-year increase of 115%. We see total healthcare costs increase at a similar clip — $4.8 trillion in 2023, representing a one-year increase of 7.5% and a five-year increase of 33%.
And each year, the typical questions abound: How do we curb the costs of care? How and where can we make cuts to reduce medication spending? What specific medications are driving the cost increases, and what additional scrutiny could be applied to ensure appropriate access and reduce spending?
In a vacuum, the questions make sense. If the goal is to manage overall healthcare spending like a family budget, we should examine categories of spending and individual line-items to identify outliers. The problem is that healthcare spending isn’t exactly like a family budget. Medication costs can’t — or at least they shouldn’t — be segmented from medical costs because, inherently, the volume and types of prescribed medications we take should impact the amount of medical care we need.
Put another way: If the figures are correct, and as a country, we’re taking more and more medications, shouldn’t that lead to a healthier population that requires less medical care? Why do medication costs and medical costs continue to increase in direct correlation, when there should be an indirect relationship between the two?
Maybe we’re too focused on the wrong metrics and the wrong conversations. Instead of decreasing medicationcosts, what if we turned those same conversations toward increasing medication value and making sure that the hundreds of billions of dollars spent on prescription drugs each year would be used optimally to improve the health of people in communities nationwide?
What would need to change to gain more value from medications?
Consider most patients’ typical experience with medications. Their physicians prescribe the medications based on how patients present in the exam room, plus the results of any lab work completed. Electronic prescriptions are sent to the patients’ pharmacy, sometimes with brief explanations of the medications, how to take them and what patients can expect — but also sometimes without that information.
Patients arrive at their pharmacies with little advanced knowledge of what they will need to pay for their new medications, whether other clinically similar medications would cost them less, and whether their insurance requires prior authorizations or step therapies. If the patients currently take other medications prescribed by different physicians or filled at different pharmacies, unforeseen medication interactions could occur.
Pharmacists and their teams often serve as the “last line of defense” in these scenarios, the final checkpoint before patients receive their medications and proceed on their health journeys. But so many pharmacists in traditional retail settings are pushed to dispense medications at such a high volume that it leaves little time for patient counseling and in-depth medication review. The current model leaves even less time for creating individual connections with patients to address deeper issues, such as medication biases and fears, affordability barriers and other social determinants of health.
To tap into the full value of medications, we first need to lean on the full value of pharmacists. That starts with creating abundant pharmacist availability to serve as trusted advisors that physicians can turn to for medication guidance.
Pharmacists in team-based care models can create new value
“I have a patient who is presenting with conditions X, Y and Z. She’s already taking medications A, B and C. What should we take into consideration if we add medication D?”
This is the type of conversation between physicians and pharmacists that should occur regularly as a standard course of care, especially for patients with chronic and complex conditions. A team-based approach would keep prescribing decisions and care plan direction firmly with physicians, and would also allow pharmacists’ deep medication expertise to shape and improve the overall care experience by ensuring patients receive the best, safest, most cost-effective medications.
We already see this approach yield positive results in other care settings. In a 2016 study published in the International Journal of Clinical Pharmacy, researchers observed a 78% reduction in medication-related problems as a result of pharmacist interventions during daily medical rounds in health systems.
Pharmacists’ value extends to the patient experience as well. As physicians invite and involve pharmacists to participate as allies in care delivery, the gaps we see in today’s typical medication experience begin to recede.
Perhaps we’ve grown numb to the statistics, but that doesn’t make them any less concerning: 65% of older people may be on medications they don’t need; up to 60% of patients — especially those with chronic conditions — demonstrate poor medication adherence. All of these common challenges in patients’ medication experiences impact annual healthcare costs through wasted medication expenses, diminished health outcomes and poorer quality of life for millions of people nationwide.
Pharmacists can help identify and resolve these exact issues by building relationships with patients, understanding their motivations and their challenges. Pharmacists can actively work to remove duplicate or unnecessary therapies, educate people about the importance of their medications and how to take them, guide patients toward coupons or other programs that remove affordability barriers.
Working in collaboration with physicians and patients, pharmacists could be instrumental in finally realizing the full value of our national medication costs, which would logically lead to healthier populations, lower total costs of care and a more sustainable system of healthcare delivery.
Photo: cagkansayin, Getty Images
Tony Willoughby, Pharm.D., is the CEO of Stellus Rx. Previously, he served as President of Catalyst Health Group, creator of Texas’ largest clinically integrated network of independent primary care physicians, and as co-founder of Thrive Pharmacy Solutions, which would eventually become Stellus Rx. Tony has more than 20 years of pharmacy and operational leadership experience, which has bolstered his passion for building solutions that help people make the best and most sustainable decisions for their health.
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