A Lack of Healthcare Benefits is Causing Financial Toxicity
If you ever wondered if there was a direct link between financial stress and health outcomes, look no further. According to research compiled by Managed Care, Americans are skipping medications that could improve their quality of life because they can’t afford them. The term financial toxicity was coined by Amy Abernathy, MD, in an essay for the journal Oncology. “Out-of-pocket expenses related to treatment,” she wrote, “ are akin to physical toxicity, in that costs can diminish quality of life and impede delivery of the highest-quality care.”
The truth is many employees need help navigating healthcare benefits to lower out of pocket expenses and avoid , “financial toxicity.”
A recent study by Willis Tower Watson found that those with high levels of financial stress were twice as likely to have poor health as opposed to those without financial stress. And the longer employees go without treating illnesses the more business is affected by lost productivity and absenteeism.
Adams Dudley, MD, a pulmonologist, and Director of the Center for Healthcare Value at the University of California-San Francisco is concerned about the prescription crisis we’re facing and said that, “This problem definitely impacts the lives of patients. They’re skipping medicines or skipping other things to buy medicines.”
As a prescriber, Dudley finds difficulty distinguishing what patient pays how much for the same drug because insurance coverage varies greatly, “These days price is such a weird thing. If I give one patient Spiriva [a bronchodilator], the cost could be $10. For another patient, it may be $200 a month. And I don’t get good information about which patient is which.”
Michael A. Evans, Vice President of Enterprise Pharmacy and Chief Pharmacy Officer of Pennsylvania’s Geisinger Health System shares a spreadsheet with prescribers of available medications for a patient’s condition along with the average wholesale price (AWP) of each medication to help prescribers lower patient costs. Evans said that for prescribers, “It’s been quite eye-opening for them, helping them better understand the cost burden on the patient in front of them, and it has definitely affected their prescribing habits. We get responses like, ‘Wow! I had no idea medication A I gave was so expensive. I could certainly use medication B.’”
Evan’s cost transparency sheet offers a solution to the problem Dudley describes, but a drawback is that the AWP is the cost of the drug to the health plan and the patient combined. This makes so it difficult to determine the patient’s actual expense.
Dudley points to another pertinent issue in healthcare, the discrepancy between the cost to make a medicine and the price it sells for. He says, “To many people, $160 is a lot of money. But almost anyone would rather spend it taking the family to dinner than paying for a medicine that cost three dollars to make.”
Employers can help address out-of-pocket costs for prescriptions by being knowledgeable about insurance benefits they offer, updating employees on any changes and asking for feedback to see if the current program is meeting their coverage needs.
