Some Doctors Can See the Cost of Your MS Meds, but Will They Look?

Ed Tobias avatar

by Ed Tobias |

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Does your doctor consider what you’ll have to pay when prescribing your medications? A few months ago, I wrote that some people are skipping doses of their meds because they can’t afford their out-of-pocket costs.

In that column, one of the suggested solutions was to talk to your doctor about cost whenever a new medication is suggested. According to the Centers for Disease Control, only about 20 percent of patients have been doing that. Wouldn’t it be useful if your doctor initiated that conversation?

There’s software for that

I’ve just read about a software tool that some doctors have available that makes it easier for them to do that. According to an article by Phil Galewitz in Kaiser Health News, the tool is part of the electronic health record system these physicians use. With just a few mouse clicks, they can see how much your out-of-pocket costs will be, start the process of getting insurance approval for the medication, and find a lower-cost alternative, if there is one. But not many doctors are using it.

According to the KHN article, the Humana healthcare system has had the pricing tool available on its network for about four years. Yet, fewer than 10 percent of its physicians are using it. Some may just not want to take the time. But it may be possible that health insurance companies are not sharing their co-pay information. Or, it may be that the database in one electronic health records system includes information for some health plans and not others.

The KHN article cites the example of a drug pricing tool sold by Surescripts, which is partly owned by CVS Caremark and Express Scripts. The tool includes data from those companies, but not OptumRx, which is owned by UnitedHealth. The OptumRX drug pricing tool, on the other hand, includes data from Optum, but not Express Scripts or CVS.

“It’s a chicken-and-egg thing where doctors don’t use it because they don’t have the data for all their patients, and health plans don’t promote it to physicians because doctors don’t have the technology in place,” health information technology consultant Anthony Schueth told KHN.

The U.S. government is taking steps to ensure that doctors can access this available co-pay information, but it will only be for their Medicare patients and it won’t be available until 2021. That’s when each company providing medication insurance to Medicare patients will be required to have what’s called a Real Time Benefit Tool integrated into the ePrescribing or electronic health record systems that doctors use.

We need to ask: ‘What will this cost?’

In the meantime, we should be our own advocates and initiate a brief conversation of medication costs with our physicians. Though the doctor may not have the information at hand, his office staff can probably get it. Even if it can’t, you’ve at least made your healthcare provider aware that cost should be a consideration when a medication is prescribed. After all, what’s the point of prescribing a treatment if you’re going to skip doses in order to afford it?

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Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.


madeline newton avatar

madeline newton

i have always asked my doctor since i was told of this disease for at the time i didn't have insurance ...the office workers were the ones that knew who to contact for people with no insurance ...and where to get help from the maker of the medication and which have others that will help to pay for the meds ...and my doctor i have now to looked into if insurance would pay and how much ...i took in a payment paperwork from my insurance company's to show the full cost of the med's she had heard about the costs and read all of the information on it ...

Ed Tobias avatar

Ed Tobias

Good for you and your neuro (and her office staff), Madeline. That's the kind of partnership all patients should have with their docs.


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