decisionhealth Newsletters, Part B News - 2018 Issue 12 (December)
Listen to needs, try appeals to payers when prices keep patients from meds
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Article Overview
This article examines how prescription costs can lead patients to skip or abandon medications and describes practical workflows used by clinicians and care teams to address affordability concerns. It is geared toward physicians, nurse practitioners, care managers, and billing or administrative staff who support access to medications. The discussion covers patient outreach, counseling approaches, use of assistance resources, and insurer communication in the context of prescription coverage and affordability.
Why This Topic Matters
Medication cost barriers can affect adherence, treatment continuity, and patient outcomes. Understanding the article helps practices recognize the operational and communication steps used to support patients who cannot afford prescribed therapies.
Article Sections
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Patient encounters
Introduces survey findings about medication abandonment and the broader issue of patients not filling prescriptions because of cost. Also frames the topic as a patient access and practice workflow concern.
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The counseling approach
Describes how some specialty practices discuss medication affordability with patients and coordinate support resources. Focuses on workflow themes, patient counseling, and access assistance programs.
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Get them to talk
Explains the importance of patient communication and rapport when affordability is a concern. Highlights clinical communication strategies for encouraging patients to discuss financial barriers.
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Lower price, same effect
Covers general approaches to evaluating lower-cost therapeutic alternatives and the need for providers to understand relative medication pricing. Discusses medication access considerations without specific prescribing guidance.
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Pitch the payer
Summarizes payer communication and appeal workflow concepts used when a patient needs coverage support. Includes general discussion of supporting documentation and insurer correspondence.
What You Will Learn
- How medication affordability affects prescription fill behavior
- How some practices organize patient counseling around medication costs
- Ways clinicians may encourage patients to discuss financial barriers
- Why payer communication can be part of access support workflows
- What kinds of operational resources may be used to help patients with drug costs
Who Should Read This
- Physicians
- Nurse practitioners
- Specialty clinicians
- Care managers
- Practice administrators
- Billing and revenue cycle staff
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