Physicians often reluctant to discuss drug costs

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Even though physicians are aware that the cost of medications can be a problem for their patients, being rushed for time and fear of embarrassing their patients may prevent them from broaching the topic during office visits, investigators report.

“Patient-physician communication about out-of-pocket medication costs is important but neglected,” lead investigator Dr. G. Caleb Alexander told Reuters Health. “Our prior work found that about two thirds of patients reported a desire to talk with physicians about their out-of-pocket cost and about 80 percent of physicians believe patients want to discuss these costs.”

By contrast, “only 35 percent of physicians and 15 percent of patients reported ever having discussed” these issues, he added.

For their current report in the Archives of Internal Medicine, Alexander and his colleagues at the University of Chicago performed a national random sample survey of 519 physicians to quantify barriers to communication and strategies to help patients with out-of-pocket medication costs.

When asked about barriers to such discussions, the most common were insufficient time (44.3 percent), patient discomfort (35.0 percent), and simply not being in the habit (33.9 percent).

More than one quarter of respondents believed there was no solution to the problem, but some physicians in the survey did use strategies to address the problem. Most common were switching to a generic drug, giving patients office samples and discontinuing nonessential medications. Other options included prescribing higher doses and telling patients to split the tablets, and referring patients to pharmaceutical company assistance programs.

“There’s probably no sector of healthcare spending where cost sharing affects a greater proportion of patients than prescription drugs,” Alexander noted. “But physicians don’t receive a lot training to conduct these discussions, and some patients may feel concern that their care will be compromised if they raise this issue.”

As a result, patients are apt to not fill their prescriptions or skip or stretch their medications because of costs, he added.

SOURCE: Archives of Internal Medicine, March 28, 2005.

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