Eliminating the economic toxicity of heart disease

Heart disease is the leading cause of death in the United States, killing nearly 700,000 people each year. Cardiovascular disease (CVD) is not only potentially fatal but also costly.

According to the latest data from the American Heart Association, CVD resulted in more than $226 billion in direct costs and nearly $152 billion in lost productivity and mortality between 2017 and 2018. During the same period, CVD accounted for 12% of total U.S. healthcare spending, more than any other diagnostic group.

Fortunately, new legislation could help many people with cardiovascular disease afford existing treatments. The recently passed Inflation Reduction Act would cap out-of-pocket prescription drug costs for Medicare Part D beneficiaries at $2,000 per year. This includes medications that help prevent blood clots, lower blood pressure and cholesterol, and promote heart health.

Harvard researchers estimate that the spending cap would benefit more than 1 million Medicare beneficiaries with cardiovascular risk factors or conditions, saving a total of $1.7 billion annually. However, the rule won’t go into effect until 2025, meaning seniors won’t get immediate relief. What’s more, research shows rising rates of cardiovascular disease among young people, who also face affordability challenges.

In this environment, pharmacists, technicians, and other pharmacy professionals can play a vital role in ensuring that heart disease patients receive life-saving, affordable care.

Financial toxicity is a common adverse effect of high-cost chronic diseases, and cardiovascular disease is no exception. Even with health insurance, one in 10 low-income households still bears the “catastrophic medical costs” of atherosclerotic cardiovascular disease (ASCVD), a study finds.

While medication adherence is critical to maintaining heart health and preventing serious cardiac events, patients struggling financially often skip, delay, or forego treatment. In fact, 1 in 8 ASCVD patients (representing nearly 2.2 million U.S. adults) report failure to adhere to medication due to cost.

The consequences not only affect individual patients but also the entire health system. Those who don’t take their heart medications as prescribed may find their condition worsens, requiring more serious and expensive medical intervention. Comorbidities resulting from poor disease control, escalation of care, and increased hospitalizations are associated with increased medical costs for cardiovascular disease patients and health care providers.

For pharmacies, affordability challenges often lead heart patients to abandon their prescriptions. For example, one study found that as many as one-third of patients dropped their cholesterol-lowering medications. Out-of-pocket costs were the main reason, with less than 10% of patients with out-of-pocket costs of $0 failing to collect their prescriptions and 75% of patients with out-of-pocket costs of more than $375 failing to collect their prescriptions.

Supporting people with heart disease and reducing abandonment

Pharmacy professionals have long played an important role in ensuring patients can afford treatment. Pharmacists, pharmacy technicians, and other staff can support patients when managing heart disease costs by:

Lead with communication and compassion

Actively discussing patient cost issues can have a huge impact. These conversations should happen as early as possible—before patients fill their prescriptions and find they can’t afford the out-of-pocket costs.

Provide patient education about low-cost options

Generic drug options are available for many common heart conditions; however, patients may not be aware of their options or know to ask. Pharmacy teams can take the lead in guiding patients toward more affordable options.

Explore financial aid

Some heart conditions require expensive special medications. In these cases, the pharmacy team should seek financial assistance from the patient. If patients have commercial insurance, pharmacy staff can help them enroll in drug manufacturer copay assistance. For patients with government insurance, pharmacists and technicians should explore disease-specific charitable funds—although such funding for heart disease is limited due to widespread use of generic drugs. The manufacturer’s Free and Alternative Medicines Program provides drugs at no cost to uninsured and eligible insured patients.

Leveraging Financial Navigation Technology

For many pharmacies, the process of matching patients for financial assistance is often manual, cumbersome, and reactive. This takes time away from patient care and results in lost opportunities to maximize available assistance. Fortunately, technology solutions can streamline the process by proactively flagging high-risk patients, creating comprehensive lists of funding opportunities, and automating enrollment. These platforms also help health system specialty pharmacies manage free and replacement drug orders, allowing staff to track relevant details in one centralized space.

Improving Heart Health Affordability

The economic impact of heart disease can have serious consequences for patients, pharmacies, and the health system as a whole. Pharmacy teams are uniquely positioned to guide patients to affordable treatment options and important financial resources. Through a proactive, technology-enabled approach, they can help more patients get and adhere to prescribed treatments. Their valuable services will reduce the cost burden of CVD and increase patients’ chances of living longer, healthier lives.

About the author

Ian Manners is chief strategy officer and head of life sciences at TailorMed.