Strategies to reduce out-of-pocket medication costs for Canadians with peripheral arterial disease

• Published in: Canadian Journal of Surgery Vol. 67; no. 1; pp. E1 - E6
• Main Authors: McClure, Graham R, McIntyre, William F, Belesiotis, Peter, Kaplovitch, Eric, Chan, Noel, Bhagirath, Vinai, Chahill, Gurneet, Hayes, Abigail, Sohi, Gursharan, Bordman, Wendy, Whitlock, Richard P, Anand, Sonia S, Belley-Côté, Emilie P
• Format: Journal Article
• Language: English
• Published: Canada CMA Impact Inc 01-02-2024; CMA Impact, Inc
• Subjects: Cardiology; Care and treatment; Clopidogrel; Cost control; Costs and Cost Analysis; Drug Costs; Drugs; Drugs, Generic - economics; Drugstores; Economic aspects; Generic drugs; Health Expenditures; Humans; Medical care, Cost of; Medical research; Medicine, Experimental; Methods; Ontario; Out-of-pocket expenses; Patient compliance; Peripheral Arterial Disease - drug therapy; Peripheral vascular diseases; Pharmacists; Pharmacy; Prescribing; Prescription drugs; Prescription writing; Rivaroxaban; Socioeconomic factors; United States; United States; Ontario; Canada; Ontario Canada
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.003722

Given that peripheral arterial disease (PAD) disproportionately affects people of lower socioeconomic status, out-of-pocket expenses for preventive medications are a major barrier to their use. We carried out a cost comparison of drug therapies for PAD to identify prescribing strategies that minimize out-of-pocket expenses for these medications.
Between March and June 2019, we contacted outpatient pharmacies in Hamilton, Ontario, Canada, to assess pricing of pharmacologic therapies at dosages included in the 2016 American College of Cardiology/American Heart Association guideline for management of lower extremity PAD. We also gathered pricing information for supplementary charges, including delivery, pill splitting and blister packaging. We calculated prescription prices with and without dispensing fees for 30-day brand-name and generic prescriptions, and 90-day generic prescriptions.
Twenty-four pharmacies, including hospital-based, independent and chain, were included in our sample. In the most extreme scenario, total 90-day medication costs could differ by up to $1377.26. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee and delivery cost, if any.
By opting for prescriptions for 90 days or as long as possible, selecting the lowest-cost generic drugs available in each drug class, and identifying dispensing locations with lower fees, prescribers can minimize out-of-pocket patient medication expenses. This may help improve adherence to guideline-recommended therapies for the secondary prevention of vascular events in patients with PAD.