Pricing in DTC: Adjusting to the New World

The Health and Human Services (HHS) final rule requiring the inclusion of price in televised direct-to-consumer (DTC) for pharmaceuticals will soon be upon us. The rule applies to all pharmaceuticals reimbursable under Medicare/Medicaid with a cost greater than $35 per month. The price, reflecting a month of treatment for chronic therapy or a typical course for non-chronic drugs, must be displayed in legible text at the end of the advertisement (prices must be updated quarterly). 

A disclaimer stating, “If you have insurance that covers drugs, your cost may be different,” is allowed. That may be scant relief, however, for the pharmaceutical executive who is concerned that patients may not seek the care they need out of concern over cost. Since patient abandonment of therapy due to cost has been proven over and over, pharmaceutical manufacturers should plan for a DTC strategy to minimize the risk. Here are a few approaches to consider, both in front of and behind the scenes.

Pair the messaging

Drugmakers have become accustomed to making a quick mention in DTC that, “Support programs are available,” or that, “Patients may pay no more than xx dollars for their prescriptions.” However, with pricing information now being mandatory in the DTC, informing potential patients about copay support offerings is more important than ever. Pharmaceutical organizations should consider pairing the talk track on copay support programs at around the same time that the price is featured. 

Emphasize that these programs can help patients find support as well as do an investigation, if applicable, into what the patient may actually pay. This can give the patient immediate reassurance that, despite the cost shown on the DTC, there are ways to afford the drug, especially in situations of limited or no insurance.

Get the hub ready

If patients perceive the cost as unaffordable, there is a very real risk that they may not seek care at all. Prescribers can reduce the risk of this if prescriptions are sent directly to the pharmacy or to a hub program rather than handed to the patient. Pharmaceutical manufacturers can detail providers on the services offered by a product’s hub program, if available, with an emphasis on the benefit investigation and connection to support programs. 

Leveraging the hub will help the patient understand his/her actual out-of-pocket cost rather than what was seen on DTC. The drug manufacturer will also benefit from having more patients and providers connected to the hub, which may increase brand loyalty.

Be on the lookout for abandoned care

Even the best hub program cannot be expected to catch every patient. Identifying and addressing abandonment of care will be a responsibility shared across the industry. For integrated delivery networks (IDNs) and health systems, there may be a need to develop algorithms in the electronic health record (EHR) to flag certain combinations of demographic and disease information for higher risk of abandonment. These patients should be monitored more closely, with regular follow-up. For payers, the claims system may identify gaps in refilling pharmaceuticals as well as ICD-10 codes that do not have corresponding pharmaceutical treatment. Payers may consider programs to identify and reach out to these patients if such a program is not in place already. Manufacturers can help both payers and IDNs by identifying risk factors for abandonment and providing these stakeholders with the information.

Drug pricing in DTC represents the latest step in the healthcare environment moving toward value and transparency. Pricing creates a challenge, but it does not change some of the primary reasons that pharmaceutical DTC is in place, including driving brand awareness and disease state education. Manufacturers will undoubtedly continue to support DTC. For all healthcare stakeholders, the changes in DTC come with a responsibility to act in the best interest of the patient. Doing so will help prevent a transparent cost from turning into a hidden one. 

Jeremy Schafer is Senior Vice President, Director, Access Experience Team, Precision for Value