EXPERT ANALYSIS AT ACP INTERNAL MEDICINE

SAN DIEGO (FRONTLINE MEDICAL NEWS) – What if you could cut patient drug costs, improve adherence, and cut hospitalization by using an online tool?

“Sounds like science fiction, right? I’m here to tell you it’s reality,” Alan A. Kubey, MD, said at the annual meeting of the American College of Physicians.

During his medical internship 3 years ago, Dr. Kubey met an 83-year-old woman on Medicare Part A and B, but not D, coverage. She was on a cardiology service, came in with a non-ST segment elevation myocardial infarction, and was treated conservatively. “She confided in me that it was hard for her, on a fixed income, to afford her medications and to do the things she loved to do,” said Dr. Kubey, who is now a hospitalist at Mayo Clinic, Rochester, Minn., and at Thomas Jefferson University Hospital, Philadelphia. After researching pharmacy options online, Dr. Kubey told the patient that he could get her medication cost down from $465 per day to $65 per day. “She was blown away, and I was blown away,” he said. “It seemed too good to be true. I then did a long retrospective analysis of patients in similar situations.”

Working in partnership with GoKart Labs and GoodRx , Dr. Kubey and his associates at Mayo Clinic are developing an online tool that enables clinicians to determine the most affordable medication choice for patients at the point of order entry.

During the ACP’s “Dragon’s Lair” competition at the meeting, Dr. Kubey earned the top prize of $7,500 to study the idea further. To date, he and his fellow researchers have used the tool for 25 patients and have saved each one about $5,600 per year in medication costs. Specifically, average costs have dropped from $6,282.54 per year to $598.84 per year, a savings of 88%. “Our plan now is to prospectively validate this in a small, single-site trial to show that this works,” he said. “If it does, we want to study it and develop it further and provide it more broadly to empower clinicians to improve the lives of patients.”

Each year, patients in the United States spend $325 billion on outpatient medications that hold the power to improve health and to save lives. “Yet, we know that up to 45% of patients don’t fill those scripts because of cost,” Dr. Kubey said. “Medication nonadherence leads to an additional $100 billion to $300 billion per year in excess care and an incalculable human cost in lost health. Providers are responsible for guiding patients in their medication decision making, yet study after study shows that physicians are woefully ill informed on the cost of medications. Yet even the astute clinician faces a Byzantine landscape that makes no sense, where a medication may cost up to 69-fold from one pharmacy to the next. What are we to do?

“We believe that you have to do it at the point of entry. There are innovative tools for patients like GoodRx, but, in my opinion, that puts too much on the patients’ shoulders. We want to bring this information directly to the provider – to build upon the progress that the likes of GoodRx have accomplished and add our advanced algorithm to rapidly empower the physician to send the patient to the most cost-effective pharmacy for the most cost-effective regimen on day 1.”

Dr. Kubey reported having no financial disclosures.

dbrunk@frontlinemedcom.com

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