Vincent Rajkumar: We as doctors should take cost into account when prescribing tests and treatments

Vincent Rajkumar, Editor-in-Chief, Blood Cancer Journal, shared  a post on X:

“We as doctors should take cost into account when prescribing tests and treatments. Medicine is the one area of life where the buyer of services has often little control over cost or options. Out of pocket costs may be markedly different depending on what we choose.

I know it may be hard for doctors to know what anything in medicine costs, especially in the US —let alone what the out of pocket cost differences are with various insurance policies. I also know doctors are in a time crunch. Here are some ideas.

Just ask patients one question about affordability. We may find that they have good insurance with fixed copay or reasonable annual out of pocket max. Or we may find they are going to struggle a lot. Knowing the situation helps.

Let’s make it a principle that when two options are equivalent to support the lower cost option. Including generics and biosimilars. As much as possible let’s try to know not just efficacy and safety differences but also price differences.

Nowadays a simple Google search especially the AI summaries Google provides let us find out comparative prices are between options fairly quickly. Especially for tests and drugs. It’s going to keep improving. It may not be accurate. But at least we will get an idea.

If it’s a generic medicine check out Mark Cuban Cost Plus Drug Company. Even if you don’t end up using them, you will quickly know the difference between the usual list price and the lowest selling price and then you can decide. It can vary a lot.

The other resource I use for both brand and generic meds is GoodRx coupons and comparative prices across pharmacies. Prices can be quite different.

Occasionally Costplus and GoodRx prices out of pocket are lower than even the insurance copay. Patients should at least know the options. If you don’t have time we can just tell them about these web sites. They can do their own research and get back to you.

Experts and guidelines should really advocate for low priced options and provide comparative guidance Here are a number of key statements written by the No. 1 CML expert Hagop Kantarjian on CML treatment options taking cost into account. Such clarity in recommendations is needed.

I’m headed to a discussion on two equivalent options and how we should go about it. This thread is a reminder to self about the importance of these discussions and the principles.

I hope AI really helps in this area. It’s one AI can have a great impact. Preferably if it can just be integrated into the medical record and based on insurance, comparative efficacy and cost differences it can give us a recommendation. Now that’s something epic EPIC can do.”

Source: Vincent Rajkumar/X

Vincent Rajkumar is a Professor of Medicine at the Mayo Clinic in Rochester, Minnesota, and Chair for the Mayo Clinic Myeloma, Amyloidosis, and Dysproteinemia Group.  He also chairs the Board of directors of  The International Myeloma Foundation and the Eastern Cooperative Oncology Group (ECOG) Myeloma Committee. His extensive contributions include over 230 peer-reviewed publications, predominantly focusing on multiple myeloma and related plasma cell disorders. Furthermore, Dr. Rajkumar is a Section Editor for multiple myeloma and related disorders for Leukemia and an Associate Editor for the Mayo Clinic Proceedings.