Strategies to Reduce Out-of-Pocket Medication Costs for Canadians Living with Heart Failure

Abstract

Introduction

Daily medication is the cornerstone of evidence-based therapy to reduce mortality and morbidity in patients with heart failure (HF). Up to 20% of Canadian patients pay for medications out of pocket. We sought to identify strategies that patients and prescribers can employ to reduce these costs.

Methods

We collected data from outpatient pharmacies in Hamilton, Ontario. We determined prices for different medications in each of the drug classes recommended for HF with reduced ejection fraction in the Canadian Cardiovascular Society’s guidelines. We examined differences in dispensing and delivery fees and inquired about other cost-saving strategies.

Results

We collected data from 24 different pharmacies, including a selection of hospital-based, independent, and larger chain pharmacies. In the most extreme scenario (i.e., 90-day prescription instead of a 30-day prescription and the least expensive generic drug instead of the most expensive brand name drug), total medication costs can differ by up to $495.56 per month. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee, and delivery cost.

Conclusions

Prescription content, dispensing practice, and pharmacy choice can remarkably impact out-of-pocket costs for HF medications. Prescribers can reduce costs by writing 90-day prescriptions and choosing the lowest-cost generic drugs in each therapeutic class. Patients should consider the services received for their pharmacy dispensing fees, use free delivery services where needed, and request inexpensive generic drugs. Pharmacists can facilitate cost minimization without compromising therapeutic efficacy.

Appendices

Appendix 1. Questionnaire

Appendix 2

Appendix

Table 5 Evidence-based pharmacologic therapies recommended by the Canadian Cardiovascular Society [1]

Appendix 3

Table 6 Pharmacies contributing data (refer to Table 1)

Appendix 4

Table 7 Sensitivity analysis: pharmacies in Toronto and Winnipeg. Pharmacy services and prices for a 30-day supply of select agents, exclusive of dispensing fees