Es Dpp4i Cost Discussion

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name: es-dpp4i-cost-discussion
description: Discuss cost and overall acceptability of a DPP4 inhibitor with the patient when there are plans to continue the medication after hospital discharge. Trigger phrases include: "Patient wants to continue DPP4i after discharge, should we discuss cost and access?" or "Need to address affordability of sitagliptin/linagliptin before discharge."
---

# Discuss Cost and Overall Acceptability of DPP4i After Discharge

## STEP 1 — Gather Information
- Confirm the specific DPP4i prescribed (e.g., sitagliptin, linagliptin, alogliptin) and dose.
- Verify discharge plan includes continuation of the DPP4i.
- Assess patient’s insurance status (Medicare Part D, private, Medicaid, uninsured) and prior experience with medication costs.
- Ask about any financial concerns or barriers to obtaining the medication.
- Review medication list for potential interactions or duplications.

## STEP 2 — Rule In / Rule Out
- Is there a plan to continue the DPP4i after discharge?  
  - **Yes** → Proceed to discuss cost and acceptability.  
  - **No** → No further cost discussion needed for this medication; document decision and move to discharge planning.

## STEP 3 — Classify or Stratify
- Determine affordability tier:  
  - **Low concern** – Insurance covers with minimal copay (<$25/month) or patient assistance program available.  
  - **Moderate concern** – Copay $25–$75/month or prior authorization required.  
  - **High concern** – No coverage, high out‑of‑pocket (>$75/month), or patient expresses inability to pay.

## STEP 4 — Decide
- If low concern: Confirm plan, provide prescription, and remind patient to use pharmacy benefits.  
- If moderate concern: Explore formulary alternatives, manufacturer copay cards, or patient assistance programs; involve pharmacy or social work if needed.  
- If high concern: Consider switching to a lower‑cost agent (e.g., generic metformin if appropriate) or discuss with prescribing team; document shared decision‑making and provide resources for financial aid.

## Clinical Guardrails / Mimics / Pitfalls
- Do not assume the patient can afford the medication without asking.  
- Do not overlook the need for prior authorization, which can delay therapy.  
- Avoid prescribing a DPP4i if the patient has a history of non‑adherence due to cost without addressing it.  
- Do not ignore health literacy; use plain language and teach‑back to ensure understanding of cost‑saving options.

## Concrete Clinical Example
A 68‑year‑old woman with type 2 diabetes is hospitalized for pneumonia and started on sitagliptin 100 mg daily. She plans to continue it after discharge. During discharge planning, the clinician asks about her insurance; she has Medicare Part D with a $40 copay. The clinician informs her about the manufacturer’s copay card that can reduce the cost to $0 for the first year and provides the enrollment website. The patient confirms she will use the card, and the prescription is sent to her pharmacy.

**Source:** Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278