Course 2: Improving Value at the Bedside (Modules 6-7) > 9.Decreasing Medication Out-of-Pocket Costs for a Patient

9.Decreasing Medication Out-of-Pocket Costs for a Patient

MODULE 6 | Section 9 of 10

Decreasing Medication Out-of-Pocket Costs for a Patient

DECREASING OUT-OF-POCKET COSTS: SCENARIO

This interactive is adapted from an exercise originally developed by Dr. Vineet Arora from Costs of Care and the University of Chicago.

 

You see a 62-year-old man, Frank Todd, in urgent care who was recently discharged from the hospital after he got a cardiac stent for an acute myocardial infarction (“heart attack”). On discharge, he was started on: Aspirin 81mg daily, Crestor 20 mg daily, Toprol XL 50mg daily, Zestril 10 mg daily, and Brilinta 90mg twice daily for one year.

 

He was discharged to cardiac rehabilitation. While there, he reported depression and was started on Cymbalta 30 mg daily. He was then sent home.

 

When he went to fill his prescriptions, the pharmacist charged him $525 dollars. His current insurance does not include a pharmacy benefit. He is having trouble affording these medications and asks you for your advice.

 

Below is a chart with Mr. Todd’s prescriptions and their associated costs. What can you do to help lower his out-of-pocket costs?

TOOL BOX

Toolbox

JAMA’S “PRESCRIPTION DRUG PRICES IN THE US”

STATIN CONVERSION CHART

$4 DRUG LIST

CONSUMER REPORT’S CAN I SPLIT THAT PILL? CHART

THE ORANGE BOOK

GOODRX.COM

You may use the tools in the provided toolbox as well as any appropriate resource on the Internet to find new ways to save money for Mr. Todd. It is not appropriate to send Mr. Todd to overseas or out-of-country pharmacies, as these may not abide by United States regulations and standards. This may be the case for some American-based online pharmacies as well. Be sure to do your due diligence to protect Mr. Todd!

Otherwise, be creative.

HELP MR. TODD DECREASE HIS OUT-OF-POCKET PRESCRIPTION COSTS
In the chart below, you will see each drug Mr. Todd is prescribed as well as the price his local pharmacy charges for these. Through the tools in the Tool Box, strategies described in this module, and elsewhere, find lower-cost alternatives to these medications. Enter the new cost in the Cost (Solution) column, and describe how you found that price in the Solution Description column.

Once you’ve submitted, you will be able to check out the top solutions.

Click here for an example solution.


DRUG COST
(Local Pharmacy)* 		COST
(Solution) 		SOLUTION DESCRIPTION
(i.e., $4 med list/90-day supply)
CRESTOR (ROSUVASTATIN) 20MG DAILY $ 99.50 $
TOPROL XL (METOPROLOL SUCCINATE) 50MG DAILY $ 39.77 $
ZESTRIL 10MG DAILY $ 6.45 $
BRILINTA (TICAGRELOR) 90MG TWICE A DAY $ 353.75 $
ASPIRIN 81MG DAILY (BAYER OTC) $ 6.49 $
CYMBALTA (DULOXETINE) 30MG DAILY $ 18.13 $
TOTAL $ 524.09 $

* Pricing based off of Express Script quotes before insurance coverage

Submit


DRUG COST
(Local Pharmacy) 		COST
(Solution) 		SOLUTION DESCRIPTION
(i.e., $4 med list/90-day supply)

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