Barriers to Medication

Mark Mikkelson, RPH

The following scenario plays out thousands of times daily in pharmacies and hospitals throughout the country:
patients having trouble paying for their medications ask the pharmacist, “Is there anything I can do without or cut
the dose to make my supply last longer?” As pharmacists, that is a conversation we hope our patients are comfortable
initiating. Having patients unilaterally deciding what medications to reduce doses or decrease frequency of in order
to stretch their budget should be strongly discouraged. Something as simple as reviewing their insurance plan may
fin a via le alternative in a ru class t at ma save un re s llars per ear e statin class r c lester l
mana ement is ten an area t start, as i erent plans ave i erent pre erre a ents everal anti pertensive
drugs are the same price per tablet regardless of strength, so cutting higher dose tablets may be a reasonable option.
Evaluating their regimen on a regular basis can also alert the pharmacist to medications that may no longer be
necessary. For example, a proton pump inhibitor initiated in the hospital and continued at discharge may be no
longer appropriate. All of these interventions are valuable in optimizing drug regimens for patients and ensuring that
essential me icati ns are taina le an a r a le

Unfortunately, the affordability of essential medications has become the driving force in
the equation.

As an oncology pharmacist I am confronted daily with costs per month that are staggering. For most patients
intravenous chemotherapy is covered, but oral chemotherapy agents fall under their prescription coverage, usually
Medicare part D. Some cancers have been transformed into chronic diseases necessitating lifelong maintenance
t erap t as een rep rte t at ne t ree patients it insurance file r ankruptc in an e rt t pa r t eir
medications. Clearly the support mechanisms put in place by the pharmaceutical industry have helped, but often
fall short.

All of these factors bring me to an ethical dilemma. Recently, at the American Society of Clinical Oncology (ASCO)
in June 2017, the results of two studies revealed practice changing results in the treatment of prostate cancer. If
fully implemented this paradigm shift will result in the addition of Abiraterone/Prednisone to standard androgen
deprivation therapy for many patients. Currently Abiraterone costs approximately $ 9000/month. Even for insured
patients t e c pa ma e una r a le e stan ar se r A irater ne is m m capsules ail n
an empt st mac everal scientific rep rts an a multicenter, ran mi e , p ase stu reveal t at e uivalent
results are achieved with only 250mg taken daily with a low fat breakfast. Is it possible that the lower dose would
e e uall e ective at l er c st ace it t e p ssi ilit patients n t takin t eir me icine at all, supp rt
em racin t is strate elievin it in n a vi lates t e first n arm rule c ntinue t success ull
advocate for our patients, clinicians across the healthcare spectrum must not only seek out the latest clinical
developments, but the barriers that exist to implementing them. g

T HE O P E N J O UR NAL • F AL L 2017 - 21 -