Rising out-of-pocket costs

KEY TAKEAWAY: TransUnion Healthcare found patients’ average out-of-pocket costs rose to $1,813 in the fourth quarter of 2017, up 11 percent from $1,630 in the same period the year prior. The analysis also broke down the amount of patient out-of-pocket costs. TransUnion Healthcare said researchers found, on average, nearly half of patients out-of-pocket costs per healthcare visit (49 percent) were lower than $500 in 2017. Thirty-nine percent were $501 to $1,000; and 12 percent exceeded $1,000.

About 8% of adult Americans don’t take their medicines as prescribed because they can’t afford them . Insurance coverage often influenced this money-saving strategy.

Among younger adults (those under age 65), 6% who had private insurance skipped medicines to save money, compared to 10% for those with Medicaid and 14% of those with no insurance. Among the poorest adults — those with incomes well below the federal poverty level — nearly 14% did not take medications as prescribed to save money.

This is effecting pharma strategic plans as well.  According to Accenture there’s a US$30B affordability gap between 2016-2021 analysts’ sales projections for NME launches and the net budget increases forecast in developed markets.  In addition list prices have seen double-digit inflation in the US between 2012-2014, but growth rates are slowing fast and increasingly offset by price discounts.

The average premium for an employer-provided family plan is now $17,545, up from $16,834 last year and from $10,880 in 2005. And workers have been paying a greater share of those premiums.  Deductibles, meanwhile, have skyrocketed. The average deductible for all covered workers is $1,280, up 70 percent from 2015.

What does this all mean?

Product benefits have become more important than the brand, according to Accentue. More than two out of three patients said that the benefits of the product were more important than the brand. Just one in three patients characterized themselves as having a strong affinity to brands in a healthcare setting. Loud and clear, it’s outcomes that matter most.

When it comes to making decisions about their healthcare and the treatments they receive, the three top factors influencing patients’ decisions are:

1ne: The doctor/ physician relationship (66 percent),

2wo: The patient’s ability to maintain their current lifestyle (55 percent).

3hree: Ease of access to the care they’ll need (53 percent).

However, what’s missing from this report by Accenture is that patients are going to balance product outcomes with cost.  As one though leader told me “my patients are asking more about cost of medication today than ever before”.   “Even with insurance the out of pocket expenses for health care are having a profound impact on patients.”

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