Although lower prices are enticing, ethical concerns surrounding this model warrant consideration and parallel those associated with concierge/cash-only dermatology practices. Refusal to accept insurance restricts the pool of patients who can benefit, specifically excluding those who depend on insurance to afford their medications, potentially further reducing access to medications for socioeconomically disadvantaged patients. The cash model could also discriminate against the sickest patients who would have to pay out-of-pocket for the most medications. Dermatologists must consider the impact that cash pharmacies can have on their patients.
S.R.F. has received research, speaking and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Leo Pharma, Baxter, Boeringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, Taro, Abbvie, Cosmederm, Anacor, Astellas, Janssen, Lilly, Merck, Merz, Novartis, Regeneron, Sanofi, Novan, Parion, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate and National Psoriasis Foundation. He is founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. The remaining authors have no conflict of interest to declare.
1. Kesselheim AS, Avorn J, Sarpatwari A. The high cost of prescription drugsin the united states: origins and prospects for reform. JAMA. 2016 Aug 23-30;316(8):858-71.
2. ASPE. Observations on Trends in Prescription Drug Spending. Available at:http://aspe.hhs.gov/system/files/pdf/187586/Drugspending.pdf. Accessed May1, 2019.
3. Iuga AO, McGuire MJ. Adherence and health care costs. Risk Manag HealthcPolicy. 2014 Feb 20;7:35-44.
4.DrScore. A Primer on Health Care Reform. Available at: http:// www.drscore.com/downloads/Health_Care_Primer.pdf. Accessed May 1, 2019.
5.Pharmacy Times. "Cash" Customer Marketplace Comes Roaring Back as High-Deductible Plans Grow. Available at: http://www.pharmacytimes.com/publications/issue/2017/june2017/cash-customer-marketplace-comes-roaring-back-as-highdeductible-plans-grow. Accessed May 1, 2019.
Steven R. Feldman MD PhD email@example.com