Cost-effective therapeutics for patients with End-Stage Renal Disease (ESRD): a guide for the practicing nephrologist
Location
Medical Education Building, LSUHSC-NO
Presentation Date
10-10-2019 10:00 AM
End Date
10-10-2019 12:00 PM
Description
For patients with end-stage renal disease (ESRD), a complex regimen of maintenance medications is needed to reduce comorbidities, with the average patient prescribed 10-12 drugs to be taken daily. High drug costs can lead to patient nonadherence and potentiate poor health outcomes, especially in uninsured patients and those with coverage gaps. However, there are options to help reduce drug costs, including foreign drug importation, mail-order pharmacies, and discounted generic drug programs. Generic drug programs provide patients with low, flat rate prices on many generic drugs. For physicians to recommend these programs and for patients to benefit from them, a detailed list of drug prices at these programs must be compiled. A web search was conducted on generic drug lists found at four national chain pharmacies: Wal- Mart Pharmacy, Kroger Specialty Pharmacy, Walgreens Pharmacy, and Rite Aid Pharmacy. The average unit drug price for each drug was calculated to include the total monthly cost, including the cost for membership for one person to the pharmacy program, if applicable. Drugs bundled with dialysis treatment (erythropoietin, vitamin D analogs, and calcimimetic drugs) were not included in the study. A total of 52 commonly used drugs to treat patients on ESRD were priced across the four pharmacies. Thirty-six of these drugs were found to be on at least one of the generic drug lists, including 20 drugs that were available on all four pharmacy plans. Antihypertensives, oral hypoglycemics, and hypolipemics were the most readily available amongst the drug classes. Insulins, phosphorus binders, and immunosuppressants were not found on any program. Kroger offered the most drugs with a total of 32 drugs found and Wal-Mart offered the least number of drugs with a total of 25 drugs. Prices of generic drug programs ranged from $4/ 30-day supply of drugs at Wal-Mart to $9.99/ 30-day supply at Rite Aid. Both Walgreens and Kroger required a paid subscription of $20/year and $36/year, respectively, while Wal-Mart and Rite-Aid were free to join. Generic drug discount plans are a possible solution to patients with difficulty obtaining their medications, such as antihypertensives, hypolipemic drugs, and oral hypoglycemics. However, drugs without generic options are not included in these programs. In such situations, patients may be able to take advantage of lower prices at foreign pharmacy companies, although legality must be considered. Mail order pharmacies offer another solution to reduce costs by eliminating retail store mark-ups. If these programs are to be taken advantage of, physicians and patients must first be aware of them. A pocket card or a mobile app with information on generic drug program prices and availability can be used by physicians in the future to better service patients.
Recommended Citation
Van Court, Blake P., "Cost-effective therapeutics for patients with End-Stage Renal Disease (ESRD): a guide for the practicing nephrologist" (2019). Medical Student Research Poster Symposium. 44.
https://digitalscholar.lsuhsc.edu/sommrd/2019/posters/44
Cost-effective therapeutics for patients with End-Stage Renal Disease (ESRD): a guide for the practicing nephrologist
Medical Education Building, LSUHSC-NO
For patients with end-stage renal disease (ESRD), a complex regimen of maintenance medications is needed to reduce comorbidities, with the average patient prescribed 10-12 drugs to be taken daily. High drug costs can lead to patient nonadherence and potentiate poor health outcomes, especially in uninsured patients and those with coverage gaps. However, there are options to help reduce drug costs, including foreign drug importation, mail-order pharmacies, and discounted generic drug programs. Generic drug programs provide patients with low, flat rate prices on many generic drugs. For physicians to recommend these programs and for patients to benefit from them, a detailed list of drug prices at these programs must be compiled. A web search was conducted on generic drug lists found at four national chain pharmacies: Wal- Mart Pharmacy, Kroger Specialty Pharmacy, Walgreens Pharmacy, and Rite Aid Pharmacy. The average unit drug price for each drug was calculated to include the total monthly cost, including the cost for membership for one person to the pharmacy program, if applicable. Drugs bundled with dialysis treatment (erythropoietin, vitamin D analogs, and calcimimetic drugs) were not included in the study. A total of 52 commonly used drugs to treat patients on ESRD were priced across the four pharmacies. Thirty-six of these drugs were found to be on at least one of the generic drug lists, including 20 drugs that were available on all four pharmacy plans. Antihypertensives, oral hypoglycemics, and hypolipemics were the most readily available amongst the drug classes. Insulins, phosphorus binders, and immunosuppressants were not found on any program. Kroger offered the most drugs with a total of 32 drugs found and Wal-Mart offered the least number of drugs with a total of 25 drugs. Prices of generic drug programs ranged from $4/ 30-day supply of drugs at Wal-Mart to $9.99/ 30-day supply at Rite Aid. Both Walgreens and Kroger required a paid subscription of $20/year and $36/year, respectively, while Wal-Mart and Rite-Aid were free to join. Generic drug discount plans are a possible solution to patients with difficulty obtaining their medications, such as antihypertensives, hypolipemic drugs, and oral hypoglycemics. However, drugs without generic options are not included in these programs. In such situations, patients may be able to take advantage of lower prices at foreign pharmacy companies, although legality must be considered. Mail order pharmacies offer another solution to reduce costs by eliminating retail store mark-ups. If these programs are to be taken advantage of, physicians and patients must first be aware of them. A pocket card or a mobile app with information on generic drug program prices and availability can be used by physicians in the future to better service patients.