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Many Patients Don't Bring Up Drug Cost Issues

Doctors Often Don't Ask and Their Patients Don't Tell About Drug Cost Concerns

WebMD Health News

Sept. 13, 2004 -- Many chronically ill older adults never tell their doctor about prescription drug cost concerns or disclose their plans to cut back on prescription medications due to the cost associated with the drugs, according to a new study.

Researchers found that two-thirds of older adults with chronic illnesses such as diabetes, heart disease, and asthma never told their health care provider in advance that they planned to cut back on their medications because of the cost, and more than a third never discussed the issue of prescription drug cost at all.

Previous studies have shown that people concerned with out-of-pocket drug costs often limit prescription drug use and don't take them as directed. Researchers say that because many older adults and people with chronic disease often take many medications, they are especially vulnerable to the pressures of rising drug costs.

Underuse of essential prescription drugs, such as cholesterol-lowering drugs, heart medications, asthma medications, and antipsychotics, has been associated with many negative health effects, including:

  • Increased emergency room visits
  • Admission to a nursing home
  • Hospitalization for serious psychiatric problems
  • Decreased overall self-reported health status

Doctors Don't Ask, Patients Don't Tell

Despite these well-known hazards, researchers say few studies have looked at whether patients discuss prescription drug cost concerns with their health care providers.

In the study, published in the Sept. 13 issue of the Archives of Internal Medicine, researchers surveyed 660 older adults with chronic illnesses who said they had underused medications in the previous year due to cost concerns.

Researchers found that the issue of prescription drug cost was often ignored by both patients and their doctors. Of those surveyed:

  • Two-thirds never told a doctor or nurse in advance that they planned to underuse their medications because of their cost.
  • 35% never discussed the issue of drug cost at all.
  • 66% reported that they had not been asked by their health care provider about their ability to pay for prescriptions.

When asked why they didn't bring up the issue of drug costs, nearly half said they were too embarrassed to have such a conversation or thought the issue wasn't important enough to raise with their doctor.

However, those who did talk with a doctor or nurse about their drug cost concerns said the conversations were helpful, and most (91%) said their provider gave them free samples of their medication.

But only 69% said a doctor had ever changed one of their medications to a less expensive one or generic alternative, 59% offered advice on which medications to skip if needed, and less than a third (30%) told them about programs that help pay drug costs.

In an editorial that accompanies the study, Alex D. Federman, MD, MPH, of the Mount Sinai School of Medicine in New York City, says the study provides an important perspective on the barriers that patients face in communicating cost concerns to their doctors.

"In regard to health care costs, when doctors don't ask and patients don't tell, opportunities are missed and patients remain at risk for underusing medications and services," writes Federman. "As the burdens of health care costs increase, physicians have a greater responsibility to direct patients to sources of assistance with health care costs when help is needed, and to select affordable therapies whenever possible."

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