This week’s tales from the counter deals with the high risk medication Zolpidem. The other day, I received a call from a patient concerned with their copay for zolpidem. The patient’s copay increased to over $90 for a 2 month supply. This was up by 200% compared to the previous refill, and she had concerns about being able to afford this in the long term. The price increase appeared to be a deliberate attempt by the plan to financially pressure the patient away from using the high-risk medication. The approved claim even included an attached note suggesting trazodone as a possible alternative.
This tactic of financial pressure to change the patient’s behavior in interesting. Unfortunately, this pressure is somewhat shortsighted. A real possibility exists for the patient to not switch medications, but instead to switch to a different discount prescription program instead of using their Medicare Part D plan. While such a switch might improve the Medicare Part D plan’s star rating (by removing the medication from their records), such a change would not actually reduce the patient’s risk.
A better way to handle high risk medication is by working directly with the patient. In fact, we had already spent time working with this patient to reduce their use of this high-risk medication. While on the phone with the patient, I read the notes we had created in their electronic chart. Here, there were several interventions regarding this same medication. Most recently, several months ago, one of our pharmacists worked with the patient and the prescriber to try a dose reduction and conversion to a different medication with lower risk. The patient did not tolerate the change, reporting several adverse drug reactions to the new drug, and reverted back to the zolpidem after a few weeks.
The increase in the patient’s copay, however, did allow us another tool to revisit this problem. Using the opportunity this financial tactic presented, we were able once again to approach the patient and attempt another conversion. The patient, like before, was open to the suggestion, and another note was sent to the prescriber.
My point is not to criticize the plan for using a financial incentive to discourage behavior in the patient, but to point out the missed opportunity. Instead of working alone, perhaps the plan would be better off partnering with the network pharmacy providers. If the plan and the pharmacy were on the same page, the potential synergy would be tremendous. Pharmacists could have discussions with the patients on high-risk medications. The patient can be informed of the risks associated with the medication and financial impact continued use will incur. Working together, the patient, the pharmacist, the prescriber and the plan could more easily persuade patients away from using high-risk medications.
The other implication to this collaboration is that there are always going to be some patients that have good justification for their continued use of a high risk medications. With the recent expansion of the Beer’s List of high-risk medications, this is even more pronounced. The plan should also allow the pharmacy to provide documentation justifying continued use of the medication. A patient with justifiable use should not, then, be counted against the plan and pharmacy’s EQuIPP scores.
