Association Between Prescription Drug Discount Cards and Out-of-Pocket Costs for HFrEF Regimens

James Wheeler; R. Eric Heidel; Annie Dong; Katherine M. Pleines; Paul J. Hauptman

doi:10.1161/circoutcomes.123.009987

October 1, 2023Circulation Cardiovascular Quality and Outcomes

Association Between Prescription Drug Discount Cards and Out-of-Pocket Costs for HFrEF Regimens

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Why the study?

Prescription discount cards may decrease out-of-pocket costs for uninsured or underinsured patients with heart failure, but the degree of financial relief they offer remains unclear.

Do prescription discount cards reduce out-of-pocket costs for HFrEF regimens compared to standard cash prices?

Structured PICO

Do prescription discount cards reduce out-of-pocket costs for HFrEF regimens compared to standard cash prices?

P

Population

Simulated pricing analysis for uninsured/underinsured patients prescribed guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) across 6 Tennessee ZIP codes.

I

Intervention

Prescription discount cards (GoodRx, NeedyMeds, and Blink Health)

C

Comparator

Amazon and Redbook cash prices

O

Outcome

Out-of-pocket costs for 30- and 90-day supplies of HFrEF regimens

Prescription discount cards offer substantial savings on generic HFrEF medications but fail to meaningfully reduce the high out-of-pocket costs of brand-name GDMT components like ARNIs and SGLT2 inhibitors.

Implication

Discount cards cut generic HFrEF regimen costs sharply but leave brand-inclusive 4-drug therapy unaffordable; leaves open whether policy interventions can close access gaps.

Abstract

BACKGROUND: The burden from medication costs for treating heart failure can be financially toxic for uninsured/underinsured patients and their families. Prescription discount cards, which offer cash price reductions, may decrease out-of-pocket costs for patients without prescription benefits, but the degree to which they offer financial relief remains unclear. Our objective was to assess the financial burden for uninsured/underinsured patients prescribed a drug from each of the 4 standard classes of medications for heart failure with reduced ejection fraction. A second objective assessed whether discounts varied across economically and geographically diverse regions in Tennessee. METHODS: This was a cross-sectional pricing analysis of guideline-directed medical therapy heart failure with reduced ejection fraction regimens utilizing prescription discount cards. Between February 9 and March 31, 2022, we conducted searches on 3 discount card websites (GoodRx, NeedyMeds, and Blink Health) for the prices of 30- and 90-day supplies of select guideline-directed medical therapy heart failure regimens for 6 Tennessee ZIP codes. Prices were compared with Amazon and Redbook prices. RESULTS: Monthly costs among discount card services varied from $10.58 to $30.86 for a generic 3-drug regimen consisting of beta blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and mineralocorticoid receptor antagonists. With the addition of a sodium-glucose cotransporter-2 inhibitor, prices increased to $540.32 to $593.74. The ideal 4-drug regimen (beta blocker, angiotensin receptor neprilysin inhibitor, mineralocorticoid receptor antagonist, and sodium-glucose cotransporter-2 inhibitor) ranged from $1188.31 to $1464.54. When compared with Amazon cash prices, the cards offered an average discount of 65% on a generic 3-drug regimen; when brand-name medications were added, discounts were modest (<12%). There were no significant variations in pricing based on ZIP codes in differing economic and geographic regions. CONCLUSIONS: Although prescription discount cards offered significant savings on generic medications, brand-name drug discounts were small and overall costs remained high. These findings highlight the potential for unequal access to life-saving therapies for heart failure with reduced ejection fraction.