Mitigating the burden of medication costs

A patient in their 60s was admitted to a medicine service for hyperosmolar hyperglycemic state. During the hospital stay, the patient developed a large pleural effusion and volume overload in the setting of diastolic heart failure and cirrhosis secondary to hepatitis B virus (HBV). The patient reported not filling an HBV antiviral prescription because of cost concerns. As the patient’s condition stabilized, the health team planned to have the patient resume HBV treatment with tenofovir alafenamide, as well as to start a sodium-glucose cotransporter-2 inhibitor for uncontrolled diabetes, heart failure, and chronic kidney disease. However, after the team provided a co-payment estimate from the hospital’s outpatient pharmacy to the patient, the patient stated that both medications were cost prohibitive. The inpatient pharmacist and medical student worked together to apply and procure medication vouchers from the drug manufacturers, which brought the monthly co-payments down to $0 and $10, respectively. After years of nonadherence secondary to cost, the patient has been taking tenofovir and empagliflozin consistently for 9 months.