February is American Heart Month, which is an excellent time to focus on the serious nature of cardiovascular disease. Heart disease takes a heavy toll, both physically and financially. People with cardiovascular disease need ongoing treatment, but many struggle to pay for it. Read on to find out how healthcare professionals can help patients get the care they need at a price they can afford.
Cost of Heart Disease
Consider the severity of the problem by looking at these statistics from the American Heart Association (AHA):
- Heart disease is the number one cause of death in the U.S.
- Cardiovascular disease (CVD) was the underlying cause of death for 874,613 people in the United States in 2019.
- CVD causes more deaths each year in the U.S. than all forms of cancer and Chronic Lower Respiratory Disease (CLRD) combined.
Heart disease isn’t just pervasive. It’s also costly. According to the most recent data compiled by the AHA, cardiovascular disease:
- Accounted for 12% of total U.S. health expenditures in 2017 to 2018, more than any other major diagnostic group.
- Resulted in $226.2 billion in direct costs and $151.8 billion in lost productivity and mortality during that time period.
This means you can’t discuss cardiovascular disease without also discussing the cost factor.
Financial Toxicity for Heart Patients
Research has established that financial toxicity is a common side effect associated with the high cost of treatment for certain kinds of heart disease. But many people don’t fully understand the steep cost of care for heart disease until they get sick, and the bills start rolling in.
Here’s an example of the costs facing individual patients: a study published in JAMA Cardiology noted that the mean annual out-of-pocket health expenditures among people with atherosclerotic cardiovascular disease were $2,227. Medication costs accounted for nearly half (45%) of that amount. The authors of the study noted, “One in 10 experienced a catastrophic financial burden owing to cumulative out-of-pocket healthcare expenses, representing nearly two million low-income U.S. families each year.”
High costs put patients in a difficult situation. They may face impossible choices: pay for medication that will keep them alive or buy food and pay the rent. One in 8 adults with heart disease will skip medications, delay filling their prescriptions, or take less medication than prescribed because of concerns over cost. They might even cut pills in half to try to stretch it out.
Unfortunately, these kinds of attempts carry big risks. For example: heart failure that goes untreated will get progressively worse. Discontinuation of a heart medication can be a potentially fatal problem.
Nonadherence also takes a significant toll on the health system as a whole, leading to about $528 billion in avoidable healthcare costs each year.
Helping Patients Overcome Cost Barriers
Heart patients may not know where to turn when it comes to overcoming affordability challenges. Providers, pharmacists, and other healthcare professionals can help ensure they have the resources they need by following the steps below:
1. Proactively address cost concerns. Tackle cost concerns with patients right out of the gate, rather than waiting until they receive a medical bill they can’t afford. Research suggests that compassion and good communication can go a long way toward encouraging adherence, and poor communication can undermine it.
2. Discuss and optimize health coverage. Make sure patients understand how their treatments are covered, and verify they’re enrolled in the most cost-effective plans. For Medicare beneficiaries, educate them about Medicare Advantage, the Medicare Savings Program, and other resources. In addition, ensure low-income patients are aware of Medicaid or other insurance options that meet their needs and budget.
3. Recommend options to lower medication costs. Many common heart conditions, such as arrhythmia and hypertension, have generic medications available that cost less than brand-name drugs and are just as effective. However, brand-name drugs are still frequently prescribed. Patients may not be aware of these options or they may be uncertain about asking, so it’s important for members of their care team to take the lead.
4. Explore financial assistance. Some heart conditions do require expensive specialty medications. In this case, it may be best to steer patients toward financial assistance programs. A few possibilities to explore include:
- Manufacturer copay assistance. For patients with commercial insurance, drug manufacturers can provide funding to help with copays, coinsurance, and deductibles.
- Foundation copay assistance. Charitable organizations offer assistance to help offset costs for patients with commercial as well as government-sponsored insurance, such as Medicare and Medicaid. For example, the PAN Foundation has specific funds for pulmonary hypertension, heart failure, and other heart conditions.
- Free drug programs. If a patient is uninsured, they may be eligible for manufacturers’ free or replacement drug programs that offer medications at no cost. This may also be an option for qualifying insured patients, as waiting for a charitable fund to open could cause a delay in treatment.
- Hospital charitable funds. Some hospitals and health systems operate their own charitable funds to help needy patients.
Optimizing Financial Navigation for Heart Health
Finding and enrolling heart patients in cost-saving opportunities requires time, knowledge, and resources that many overburdened clinicians may not have. In a hospital or health system, financial navigators have a crucial role to play in guiding patients through the process. Similarly, in a pharmacy setting, pharmacy technicians and other staff are often tasked with determining if assistance programs are available for a particular medication, as well as a patient’s eligibility. However, their efforts are typically manual, cumbersome, and reactive–which takes time away from patient care and leads to lost opportunities to maximize available assistance.
Fortunately, technology solutions can streamline the process by proactively flagging at-risk patients, optimizing their benefits, creating a comprehensive list of funding opportunities, and automating enrollment. By leveraging these platforms, providers and pharmacies can help more heart patients access and stay on treatment, improving their chances of living longer, healthier lives.
This American Heart Month, Improve Affordability
Each year during American Heart Month, we shine a spotlight on heart disease and hope to raise awareness. But the reality is that heart disease is an ongoing problem—and one that’s costly for individuals and families, as well as the entire healthcare system.
However, while it all starts with awareness of the problem, it doesn’t end there. With a proactive, technology-supported financial navigation approach, provider and pharmacy teams can help heart patients get the care they need without breaking the bank—or foregoing the treatment they need to improve their health and quality of life.