Lisa King, RPh

In terms of advice you have for community pharmacists offering this, what kind of advice do you have for them and for their patients?

 I think, honestly, the patient loyalty and the service provided to the patient—you can’t put a dollar value on that. You may not be getting quite the amount of money that you got through their co-pay, but it provides that patient loyalty. The patient knows you are looking out for their best interests. They are loyal to your store, they purchase other things while they are there, but not only that, they keep coming back to you as their pharmacist. You are able to have that great rapport with the patient. I think, for me, as a pharmacist and most pharmacists, that is what it is really all about. It is that patient connection, that we are wanting to do the best job for the patient. And one great way to do it is through the prescription discount programs [PDPs].

I always tell pharmacists, as well, that the prescription discount cards are here. We have to embrace them, begin to figure out how to use them, and see how they can best benefit the pharmacy or patients. What recommendations do you have for pharmacists who are hesitant to use them or are nervous about using them? How can they ease into using these cards?

I think finding a few cards you can offer to your patients and establishing that rapport and that loyalty with the patient is important. You do not have to take all of them. There are definitely some that are better than others, so when the patient comes in with that stack, you can say, “This is the one I recommend.” Really, we need to know the ins and outs, know which cards are your go-to cards. I know I can use these 3 cards, and they are going to provide the best prices for my patients. Just get to know the cards. Like you said, it is something that is here to stay, and the reason many pharmacists have to take them now, is because the pharmacy down the street is taking it. They do as well in order to stay competitive. It is an important thing to continue doing for patients.

Definitely; if the pharmacy down the street is taking them, you do not want to lose your patient or their business because of that. In terms of patients who have jobs, I know we touched on that a little bit, in terms of insurance co-pays and things like that, but I think that is a group that does not think about this because the person is working, they have a job, and they have insurance. Do these PDPs work for all of them as well? Does that matter if they’re employed?

Yes, absolutely. I can think of one particular provider where the co-pay would always be in the $15 to $20 range, for even generic medications. You could get the price down by almost half using a prescription discount program. For people who are using multiple medications monthly, that can be a big savings over time.

In terms of the manufacturers’ coupons, I know they encourage the use of brand name drugs, and they help you to get the brand names to go through. Do these discount cards, which are a little different, do they work on generic medications and not just brands?

Yes, these do work on generic medications. Right now, at the pharmacy where I am working [Nexus Patient Services], we work with patients who have a specific disease state. Many of the medications they are on are only brand name medications, so the discount cards do not work as well in those cases. They often work better with generics. That is very big, that we use a lot of the co-pay cards with our patients.

It is 2 different sets, almost. I think a lot of times people just want to know the differences; patients and pharmacists as well want to know, so that is very helpful. Are there any last minute thoughts you have, Lisa, on this topic that we have not covered?

I have to say I have loved using prescription discount programs. I love saving money. I am a coupon queen, so I want my patients to save money as well. I would do whatever it takes to lower that cost for patients. I do not like seeing anybody, including myself, paying more than they have to for anything. I highly encourage it. We had very loyal patients where I was at last, in my retail setting. I highly encourage pharmacists to use the card. I think it is a great service to patients.

I agree. I think, where you can save money, save it, and spend it somewhere else. Go on a trip or do something else with it. Donate it—do anything else. I agree. Thank you so much for talking to me today about this. To our viewing audience, we hope you found this 

 discussion very valuable and to be rich and informative. Thank you.

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Experts provide advice for community pharmacists wanting to explore options, such as Prescription Discount Programs, to help improve their patients’ outcomes.

Advice For Pharmacists Exploring Prescription Discount Programs

In terms of additional services for patients that could be available, what do you think could be beneficial in terms of different services that might work?

 Telemedicine comes to mind. You do not have to use gas money to go to the doctor’s office; it saves time and money to use telemedicine. I was just involved in a study promoting bladder health for women, and they were finding that through telemedicine, which has become so prominent during the pandemic, women are talking to their doctors about really embarrassing subjects, such as bladder issues. That is really helpful. Getting laboratory work done, making sure the medications you are taking are needed, and staying on top of your doctor visits, even though it’s been a little challenging in the last year or so, is all important. Patients need to make sure the medication that was originally prescribed is something that they truly need. Those are some things that come to mind when it comes to other ways to save money on medication.

I do think lab work at home is the big one. I have personally done this as well, where I have had the lab kit mailed to the house. Then, I can do a finger stick test. I did it for food allergies and sensitivities, and I thought it was a really customized lab test to do at home, but I do think those are things that could be beneficial, and save time. You are right; I did not have to drive to a lab. I did not have to go somewhere to do the test. The test came straight to my door, and I was able to do it. It was like a COVID-19 test; right now with traveling, some of the airlines have been mailing the COVID-19 tests directly to houses, and you can send them back.

I think any type of lab testing you could do in that way will save not only gas money, but time, and you just have to mail it back and get your results. For me, that is very beneficial as a patient, not just as a pharmacist, because I think you are more adherent to getting your labs tested. You do not have to take a day off of work or leave work to go have all the testing done. I think that is important as well. What do you think about monthly membership programs in terms of savings in general, whether it is a combination with the physician office and the pharmacy, or different things? I have been seeing a lot of that circling, about these membership programs. What are your thoughts on that?

 I think, if there is a good price on your medication and it is something helpful for you, then definitely that is the way to go. I think every situation has to be balanced out. As we talked about earlier, sometimes patients think prescriptions are more expensive than they may actually be. You may be thinking, “I have to join this prescription savings program in order to get the best rate,” where they may have a card you can use, and that is going to be just as beneficial. I think it is something to weigh out, but it is great. Anything you can do to have that affordability of prescriptions, different medical services, is fantastic. I know a lot of doctors are providing the concierge service where they have that 1-on-1 care. I think that has been very beneficial to a lot of my patients. They like that a lot.

I think, even in terms of the telehealth, making sure that the system you are using is HIPAA [Health Insurance Portability and Accountability Act] compliant is important.I know that, even with COVID-19, some of the physicians—my kids were sick during it, and then they had to go to the pediatrician, and she said, “We can’t FaceTime,” even though we have her number to FaceTime. She said, “We have to use this HIPAA-compliant program in order to conduct the visit.” I think the same goes with these PDP [prescription discount programs] cards, that some of themare HIPAA compliant. I think, when talking about fraudulent programs that might not be legitimate, looking at how compliant they are and if they follow HIPAA is a critical thing.

What about price, medication price comparisons, going onto a website and Googling to try to find the best price? Do you encourage or discourage that for patients?

 As I said, the only thing I really discourage about that is it results in patients sometimes going into multiple pharmacies. I would just stay with the trusted pharmacist, and I think that is one of the things the prescription discount program brings about. If you offer them to your patients and know which have the best prices, it gives that patient a sense of loyalty, and the patient feels that you are looking out for their best interests. I do not encourage patients to go from pharmacy to pharmacy. I become worried about them, to be honest, worried that they are going to have an interaction, or like you said, a duplicate medication, or something like that. I like to keep my patients in 1 spot. I was always happy I was able to do that most of the time.

Definitely. What about if you do not have a printer and you’re trying to print the card? Do you take it off the cell phone or…?

 We looked at a lot of different phones. People would take a screenshot or just take a picture of the card. My pharmacy, we were lucky, on the price comparison we were often at the lower end. We had several big chains near us, and they would send their patients to us. They would say, “We hate to say it, but you can go down here and get it for much less.” We were grateful for that.

That is great. That is important. I think digital cards are the way to go because even my own insurance cards now are digital. I was thinking it might be easier to have it on your phone to begin with

A discussion on some additional services available that could be beneficial for patients, including telemedicine, lab work, and monthly membership programs.

Prescription Discount Programs: Additional Services

How do patients or pharmacies join or participate in a program? If a patient is interested, what would you recommend if someone came to your pharmacy and was asking you about prescription discount programs [PDPs]? How would you recommend them going through step-by-step to do it?

I would recommend the cards that I found to have the best savings for the patients. For many of the cards, you may have to go online to look up a price. I would help my patients who are older, or those who did not have access to a computer. Or, I would let them know how to go about doing that for themselves and help them in any way possible. Then, as a pharmacy, I believe you just have to contact the prescription discount program and sign up with it so you can become part of their network. I think it is very easy to do, provide your different identification numbers, license, and NCPDP [National Council for Prescription Drug Programs number], that type of thing, and join as well. I am at an independent pharmacy myself, and we have our own discount programs we use, too. It is great.

Definitely, and I think it is important to realize that it is for all types of medications, too. Some people may think it is only for the really expensive medications, but you could use this for any medication, depending upon whatever area. It is not just for chronic disease medications, diabetes medications, or hypertension medications—it is for everything. Pharmacies can join as well. If pharmacies are interested, whether or not they are an independent pharmacy, depending upon who they work with, I know that certain groups have contracted with certain cards. Some of them are accepted, and certain chain pharmacies accept certain ones. I think pretty much anyone can join, but I encountered that as well with patients who did not have access to the internet. Sometimes, they had a smartphone, and so then my technician would help them go through on their smartphone, what to do and how to get the card, which definitely helped. I do not think it is a great idea to have the card sent to the pharmacy. I know that a lot of pharmacies frown upon that, and I have seen them get chucked into the waste basket. I do not think having them in the pharmacy space is a great idea; I think having access somewhere is a better idea.

Another thing I just thought of too is that so many of the cards will offer different prices at different pharmacies. I would strongly encourage patients to know that that pharmacy where I was working, or you were working, or any pharmacy, is going to get them the best price. I would encourage patients not to go from pharmacy to pharmacy. Filling their different prescriptions at different pharmacies just for the best price is not a good idea because if there are drug interactions or adverse events, different things like that, they can get pushed by the wayside and not come to the forefront where pharmacists can see them, [as opposed to] if everything is being filled in 1 place.

I agree; you want to avoid the whole polypharmacy thing related to that, in terms of drug interactions or multiple physician prescribers, and things like that. Patients may end up taking the same medication twice. It is probably not worth it. I used to tell patients that too; it is not worth your gas money, because you are not going to save the amount you might think you are by shopping like that. What are some counseling points you have given patients to help them when determining it? I know you said that you would look through it with them, but what if they were at home and trying to find the best card? What would you have them do?

I think, honestly, they can look at home, but they should talk to the pharmacist because the pharmacist is going to know what the best prices are and help them navigate this. Also, often the pharmacist really knows the price of the medications. I encountered many different times where the patient will come in and say, “My doctor said this should be $10,” or whatever it may be, and it’s quite a bit more….

And they think [the prescription is] going to be ready in 5 minutes, but it is not going to be ready in 5 minutes….

Exactly. I know, and it is funny because where I worked, we had so many clinics that were right across the street. And honestly, the patients’ drive time from the clinic over to the pharmacy was quicker than when we would get the prescription through. The same thing goes with the cost of the medication. Really, the pharmacist knows about the prices of medications. The doctors will oftentimes have those co-pay assistance cards that we talked about earlier, and that is often helpful. They will have them there through the drug representatives, but for discount cards, the pharmacist is key.

Definitely, and I think in terms of avoiding fraudulent ones, I have had patients come to the pharmacy and say, “You know what, they asked me for my credit card number, and they asked me for my bank account number.” I would say, “There is no card that would ask you for your personal financial information, and if they do, that is a red flag. That is something you want to avoid and you do not want to be using.”

What about pets? We often have patients who come in for medications for their pets. Would you recommend this for patients who want to use this for their pets?

Yes; I know some of the cards cannot be used for pets, but with many of them, you can. I think the biggest obstacle we had when using them for pets is that veterinarians do not have NPI [National Provider Identifier] numbers, and the cards have to be able to recognize the doctor in the system. Often, we would have to call the vet to get the their DEA [Drug Enforcement Administration] number, and they were hesitant to provide that because it was not a controlled substance that they were prescribing. We had to explain to the patient and to the veterinarian what was going on with the cards, but there definitely has to be some sort of number identifying the prescriber in order to use the card. That was a workaround we had to do; oftentimes, we would get that DEA number if we did not have it from previous prescriptions. But it is a great way to go, and I can think of so many different dogs we helped in this way. I am in Arizona, and valley fever is extremely prevalent here. A lot of the antifungal medications that we would have prescriptions for would be extremely expensive, and these dogs would have to be on them for months on end. The prescription discount programs were really helpful for people to be able to use with their dogs.

Experts share tips to help patients and pharmacies evaluate and participate in Prescription Discount Programs.

Prescription Discount Programs: Tips

I think time is critical, and we should not forget to talk about that. A lot of pharmacists do not have the time to compare the insurance and the cash [price], given their workload and what they are doing. I was also fortunate enough to be able to help. I was working in an independent pharmacy with very low volume, so I was able to check almost every single prescription that came in for patients to see what the best price was, and if it could even be a cash price as well. I think time is very important because otherwise, are they [prescription discount programs] easy to use? It depends on how much time you have, right? As a pharmacist, we took an oath; we want to do what is best for our patients, but sometimes, when your workload is very high, you might not have the ability to do that. I do not want to discount that at all either.

Yes, and I think it also depends on the patient going to that pharmacy. Where I was working, a lot of the patients were older, and so they may not have had access to a computer to go online to get the card or get their identification number. They really vary. Many different prescription discount programs [PDPs] that may just use a patient phone number; for others, you have to go online and register for the card. As a pharmacist, I always like to help patients do that. Then, we know which cards are better than others, because now there seem to be so many different prescription discount cards. Patients would get a card in the mail, and it really was not that big of a savings, or they would come in and say, “I saw I could get my medication for this price.” But I would know that I could actually get it for them for less on a different card. It is important to be aware and have patients be aware as well.

Yes; I agree, because sometimes I’d have patients walk in with a big stack, and I would say, “I’ve never even heard of 90% of these cards. We are not going to go through all of them.” Name recognition and being able to recognize which cards could potentially save them versus which cards are not a good idea to run or to waste anyone’s time with is imperative for pharmacists. I think that is definitely something that could help. Even as a pharmacist, being aware of that and making the technicians aware of those issues as well, has helped. I think those are some ways to improve the utility. I do not know if you have other recommendations on improving the utility of the PDPs?

I think patients need to have realistic expectations as well, because sometimes the price will vary slightly, by a dollar or two, from the price they are expecting. I think letting them know, this is the actual price of the medication, this is still a great deal, even though it is a dollar or two more—being able to communicate that for ourselves and through the technicians is important. What I found interesting that you said was that you were using these cards at the independent pharmacy you worked at, because it shows you can use them anywhere. I was working more in a chain setting, and you were working at an independent setting, and we were both able to use these cards to benefit our patients.

A discussion on some of the obstacles pharmacists may face and advice to improve the utility of Prescription Discount Programs.


Obstacles in the Way of Pharmacists Wanting to Improve Outcomes

In terms of utilizing PDPs (prescription discount programs) as a tool in optimizing patient care, we talked a little bit about what patients we might recommend it for in terms of the business owners or the families, but do you have any specific examples where you have actually witnessed a patient having improvement from medication adherence or using a PDP?

 I think, for me, 1 of the things that is so surprising is that patients often do not know exactly how much prescriptions cost. Often, patients who are in between jobs, or are facing that sort of situation, when I recommend the prescription discount program to them, they really have no idea what I am going to be telling them about the price. I can think of so many different occasions where I’ll say something like, “That’s going to be $18.00.” They’ll say, “Oh my gosh, $1,800.00.” I’ll then say, “$18.00.” They really, in their mind—they are thinking, “Okay, I had this $20 co-pay before,”—whatever it may be—and they are thinking about the worst case scenario regarding the cost of their medications because you hear so much about rising drug costs. I just love that surprise and when you can tell the patient the price and they are like “Okay; great.” That is wonderful. I can just even think of so many different occasions especially when I was working near a university where I was able to provide the patients—students from around the world—these prescription discount programs and have them be able to use them to get their prescriptions filled.

Yeah, I think—college students are a great example of patients who might not have prescription insurance or might be between insurances, whether they are on their parents’ insurance or they're from another country. That is personally when I have witnessed the benefit as well. I had a couple college students who came into the pharmacy who were needing travel vaccines as well. They were purchasing some other anti-malaria pills and different things like that. It really helped them because the cost went from 100s of dollars to less than $100.00 just for the anti-malarial medications since they were traveling out of the country. I definitely think they are another group of patients that would love to benefit from this and they could really use the extra savings. I mean I’ve seen them be able to take their medication because of this.

They can go on the trip; they are able to go.

They are able to go away. What kind of savings have you seen? Have you seen a lot of savings, when you are thinking about numbers?

 I have seen hundreds of dollars in savings. You know I have to just say that I am really super-grateful that, at the pharmacy where I worked at last, we really had so much time to be able to spend with patients and give them that extra care. I know a lot of pharmacists do not have time to compare prices, but where I was working—especially if a co-pay came up higher than we thought it would be—we were very aware of different prices on the different prescription discount programs. We would always compare prices for patients and get them the best price. I really think it really helped with that patient loyalty.

They knew, when they were coming to our pharmacy, that they were going to be getting the absolute best price on their prescription. It really just helped them to keep coming back and helped them to get to know us better, to trust us as pharmacists. I would see hundreds of dollars in savings. Then, on the other hand, I would have patients come to me saying, “I saw that this was this certain price on a prescription discount program,” but I would know that their co-pay may only be $5.00 on their health insurance. Patients really have to know to compare the prices. I was really just grateful that I was able to do that for them and have the time to be able to do that for them at my last location where I worked.

Examples of patient populations with improved medication adherence and savings achieved because of Prescription Discount Programs are discussed.

Prescription Discount Programs: Patients with Improved Outcomes

What are some financial challenges that you have seen that patients might experience?

 Well, especially in these challenging times, job loss, or even patients being in between jobs. Often patients—especially where I was working—may switch jobs and then not have health insurance for 3 to 4 months. Then they wonder, “What am I going to do? I know my co-pay used to be $5.00, and now I do not have insurance for 3 months until my new insurance begins.” I was really always so grateful that I was able to offer the prescription discount programs to patients. That is really a big thing for patients who are not having any insurance at the time. Even just offering it for other reasons—

health reasons, they may have really high co-pays for different medical reasons that they or someone in their family have—is good. Medical costs are on the rise. Really, being able to save wherever you can though prescription discount programs is just so beneficial for patients.

Yeah, definitely; I agree. I think, right now, in terms of losing jobs and unemployment rates, a lot of people are between jobs or looking for a different job. I think that those patients are finding challenges because the other issue is that something that could have been on formulary on your insurance is all of a sudden not on formulary.

Then, you might need to change a medication you are taking that might have been recommended, you may have to take something differently. What do you do if you do not have coverage or something else is recommended, and you are waiting? I do think all of those are some of the financial challenges that they could feel. It can be difficult for business owners purchasing their own insurance.

Some have very high deductibles that they are trying to meet. I had 1 when I was working in a community independent pharmacy—I had 1 patient who had almost a $10,000.00 prescription deductible, which is outrageous to me. It was very difficult for them to meet that, so the cards were definitely a solution that they could use to help them. I do not know if you have thought of other solutions that can address some of these challenges for patients.

 Yes, I was going to mention—that is the case that I am in right now. I have an extremely high deductible so I am mostly using prescription discount programs instead of my co-pay. It is really helpful. The other thing, too, is it is really helpful if a medication needs prior authorization and you are waiting for that prior authorization, which can sometimes take a bit of time. The prescription drug program is a really great way to possibly still start that medication while you are waiting for the PA (prior authorization) to come in place or have your doctor switch the medication or whatever it may be. You can still get started on your treatment.

Yeah, you know what happened to me. I take a prescription medication and it was always on formulary. Then, this year, I had to get a prior authorization and I am saying, “I have been taking this for almost 20 years. All of a sudden I needed a prior authorization.” You are right, in the interim, I will say, “Oh my gosh, what am I going to do? It could just be new insurance or something changes, and all of a sudden the insurance wants the prior auth, and you are right. My physician worked on it very quickly and so did it my pharmacy but it still took almost 2 weeks for everything to work out.

This is a great time for these cards to be used and for patients to benefit from them. I also think that sometimes, with prescriptions for children, some of the antibiotics are often more costly on insurance than they are with some of the cards. I often tell parents to check out—when they are getting an antibiotic—to check out what the other price options are because sometimes, with antibiotics, you are just at the pharmacy once or twice a year for them. You are not really thinking about cost but when you get there you just go to pay. I often recommend to patients to check the options out there for antibiotics, too. Do you have other solutions that could help patients?

 Yeah; there are several things that come to mind for patients to help with affordability of their medication. 1: ask about generic alternatives. I know my parents, for instance—my dad was prescribed a medication that was extremely expensive; it was a high-tier co-pay. They were upset. Often, patients who are older do not realize there could be an alternative medication. Definitely talk to your doctor and pharmacist about something that could be generic or a different drug in the same class that would be as effective. Another thing could be tablet splitting. If the patient is able to do that, it may be wise to talk to a doctor or a pharmacist about that, because often the higher-milligram strength will be the same exact price as the lower-milligram strength. You can get double the amount by being able to split the tablet. That is something that can be asked about as well. Many times there are different alternative medications. Really talk to your pharmacist about it because there are so many different alternatives that are less expensive and patients often do not really realize that. That is something really important for people to know as well.

Yeah, I think the alternatives are a great option; just looking at what the alternatives could be can work.

Experts discuss examples of financial challenges patients experience that impact medication adherence, and potential solutions to address these challenges.

Lisa King, RPh

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