Friday, September 09, 2022

Patients At Risk As Healthcare Navigates Affordability

Today’s guest post comes from Kristina Crockett, Vice President of Product Management at CoverMyMeds.

Kristina discusses the affordability challenges that patients face in our complex and confusing healthcare system. She then explains how data and technology can help payers, manufacturers, and providers improve medication access.

To learn more about CoverMyMeds’ comprehensive affordability solutions, download Overcoming Medication Affordability Challenges with Patient-Centered Solutions.

Read on for Kristina’s insights.

Patients At Risk As Healthcare Navigates Affordability
By Kristina Crockett, Vice President, Product Management, CoverMyMeds

Jzon lives with multiple sclerosis. He described help paying for his multiple sclerosis treatment as a “godsend” during 2020, when he had to step back from his dream of opening a brewery thanks to the COVID-19 pandemic. He counts himself as fortunate to have had insurance, but he still needed to use injectable steroid samples instead of infusions sometimes to make treatment affordable.

As costs increase, especially as treatments and technology evolve, tough decisions abound for patients.

“It’s the life-management juggling act: You borrow from Peter to entice Paul to convince Joe he doesn’t need to be paid,” Jzon said.

His voice is one of millions who are living through the confluence of trends forcing healthcare stakeholders across the spectrum to confront affordability.

  • A third of the U.S. population—111 million people—had inadequate health coverage in 2020.
  • On August 16, 2022, President Joe Biden signed The Inflation Reduction Act of 2022 into law. This enacted a historic measure that will help Americans on Medicare afford their prescriptions.
As various states seek to enact legislation aimed at drug price transparency and keeping prescriptions affordable, the patchwork of regulations and industry practices will get more confusing.

Patients, and many times providers and pharmacists, don’t know what a medication will cost until the moment it’s filled. In 2021, 79% of patients went to pick up a prescription and found it was more expensive than they anticipated, according to the 2022 Medication Access Report.

In 2022, 44% of patients surveyed by CoverMyMeds said they asked their pharmacist or provider about cheaper alternatives when their prescriptions cost too much, while 75% of providers said they talked to patients about medication affordability, despite saying they don’t trust the limited formulary and benefit data, according to the Medication Access Report.


Data and technology hold the power to change outcomes.

Cost transparency—driven by real-time communications—lets patients make informed healthcare decisions.

If providers know a drug might be costly at the time they prescribe it, they can start conversations with patients about options and assistance that might be available from manufacturers.

Medication access hurdles like prior authorization can be overcome using technology, which can simplify the PA process. Patients can receive medications 13.2 days sooner when their providers use electronic prior authorization, according to the 2022 Medication Access Report.

At the pharmacy, data can reveal why a prescription is denied, and automation can covert those prescriptions to paid in real time with funding from the pharma manufacturer. That can give the pharmacist and provider more time to counsel patients while ensuring therapy is not delayed.


A strong patient affordability program is key. Financial support such as copay and discount cards let patients begin and stay on therapy, even if they are uninsured or underinsured.

Technology can help identify patients most at risk for prescription abandonment and ensure affordability programs are sustainable for manufacturers.

With technology as the program foundation, a human touch can bring the support system home with live support for patients experiencing denials or affordability challenges. Meanwhile, bridge programs may help patients go ahead and start therapy while awaiting approval from their health plan.

Time to treatment makes a big difference in people’s lives.

Jzon said he shudders to think about how progressed his MS might be without the help he got in affording his treatments.

“(Affordability) conversations always come in to play just due to the fact that continuity of treatment in this country is dependent upon having insurance,” he said. “There's only so long you're going to go being uninsured and getting full treatment for whatever illness may fall upon you. They just don't go together.

“I've definitely been the proud recipient of quite a few samples in my lifetime that have helped to resolve these situations.”

For an in-depth look at how stakeholders can make prescriptions affordable for patients, access Overcoming Medication Affordability Challenges with Patient-Centered Solutions.

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