Patient Awareness of Local Drug Price Variation and the Factors That Influence Pharmacy Choice: A Cross-sectional Survey Study

December 2017 | Volume 16 | Issue 12 | Original Article | 1274 | Copyright © 2017

Spencer D. Brodsky BS,a Olabola D. Awosika MD MS,b Misty G. Eleryan MD,a,b Monica Rengifo-Pardo MD,a,b Xiangyu Kuang MS,b Richard L. Amdur PhD,a,b and Alison Ehrlich MD MHSa,b

aGeorge Washington University School of Medicine and Health Sciences, Washington, DC bThe George Washington Medical Faculty Associates, Washington, DC

Abstract

Background: High out-of-pocket drug expenditures are increasingly common in dermatology. Patients may not be aware that prices vary among pharmacies and consequently may not shop for the lowest cost.

Objective: To determine what factors influence pharmacy choice and the effect of providing local prescription prices on pharmacy selection. We hypothesized that patients do not “shop around” due to lack of knowledge of price variation and would choose a pharmacy based on costs if educated on price disparity.

Methods: Between July and August 2016, we administered a cross-sectional anonymous survey to adults visiting four outpatient clinics at an academic tertiary care center in Washington, D.C. Participants answered questions before and after viewing a list of prescription drug prices from local pharmacies.

Results: 287 surveys were administered to a convenience sample of adults (age ≥ 18 and literate in English). Of the 287 participants, 218 fully completed the survey; 55.1% were women and 40.5% were over age 40. When considering a cost savings of $10-25, 65% would switch pharmacies if the distance were the same, and 21.3% would switch if the distance were 45-minutes further. After price education, fewer participants felt that drug price knowledge would ultimately influence pharmacy choice (P less than 0.0001). However, respondents’ intended frequency of researching price online, calling a pharmacy to ask about price, and comparing price between pharmacies before filling a prescription all increased, compared to prior self-reported frequencies (P less than 0.001). Specifically, participants with $75,000-$99,999 income were more likely to compare prices than those with income below $45,000 (odds ratio [OR], 4.62; 95% confidence interval [CI], 1.24-17.28)

Conclusion: In this study, pharmacy choice was more influenced by convenience than cost prior to drug price education. However, price education ultimately impacted intent to research prescription drug prices before selecting a pharmacy. Thus, knowledge of drug pricing may be useful in creating cost savings for patients.

J Drugs Dermatol. 2017;16(12):1274-1280.

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INTRODUCTION

Prescription drug prices have escalated considerably in recent years, more than other healthcare costs.1 Generic medications, which represent more than 85% of all US prescriptions, have long been considered an alternative to expensive brand name drugs.2 However, as industry-wide prices have continued to rise, so too have the prices of generics. Unfortunately, some of the generic drugs that are most commonly prescribed in dermatology have substantially increased in cost and demonstrate significant price variation.3,4Despite the fact that insurance covers the majority of prescription costs, the burden of high retail prices is inevitably passed onto the consumer.5 Insurance companies have developed more restricted formularies and policies with even higher deductibles.3 Many insured patients are forced to pay a significantly higher co-pay for their medication, and sometimes, full retail price if their medication is not covered by their insurance. To help offset these costs, consumers may take less medicine than prescribed or delay filling their prescriptions.6 This practice is especially prevalent among low-income adults.6 Increasingly, individuals who are subjected to high drug costs are more likely to skip a doctor’s visit.7,8 While certainly not unique to dermatology patients, researchers have suggested that patients being treated for acne, eczema, and psoriasis are particularly prone to high out-of-pocket health care costs.9,10,11Many consumers are unaware of the retail cost of a drug and the price variation between local pharmacies. In a cross-sectional survey study of 552 patients, 52% of patients were aware of low-cost pharmacy options.12 Of this 52%, 78% were able to identify one or more of these options.12 However, in a 2015 Consumer Reports poll of 1,037 US adults, only 17% of consumers reported shopping around at other pharmacies for lower prices.8 Despite these findings, little work has been

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