Cost-Related Underuse of Medication: Do Patients With Chronic Illnesses Tell Their Doctors About It?
Between the rising costs of prescription drugs and increases in healthcare premiums, a large percentage of patients are unable to pay for the care they need to maintain their health. To offset these costs, patients who have trouble affording their prescription drugs may reduce or even stop using their medications.
If this is a prescription for a chronic illness, like hypertension or diabetes, the consequences can be devastating. Unfortunately, many of these patients do not tell their doctors in advance about their inability to pay for their prescriptions, and some never discuss the issue at all.
A study published on September 13, 2004 in the Archives of Internal Medicine evaluated what percentage of patients discussed the cost of medication with their doctors, the reasons they did not discuss these issues and how their doctors responded.
About the Study
The results of the study are based on surveys completed by 660 adults in the US, averaging 63 years of age, who reported taking medication for a chronic illness. Participants were offered free WebTV and web access for completing a total of two to four monthly surveys.
Participants who reported underusing medication due to cost were asked if they had discussed:
- Cost issues with their doctor in advance of obtaining a medication prescription
- Cost issues before or after underusing their medications
- The possibility of being prescribed lower cost medications or receiving other forms of financial assistance
Participants were also asked in what ways their doctor tried to help them with this issue.
Of the participants in the study that underused medications, 30% did not tell their doctor in advance that they would not be able to continue using their medication due to the cost, and 35% never discussed the problem at all. It was also of interest to the researchers that 66% of the participants reported that no healthcare professional ever asked them about the issue of cost, and 58% did not think that their doctors could help them with the problem of cost.
The study also evaluated what actions by the doctor would be most helpful in dealing with medications that were too expensive. Although many patients stated that conversations with the doctor would be helpful, 31% of participants reported that their medications were not changed to generics or less-expensive alternatives. For the most part, few patients were informed about other forms of assistance, like programs that help to pay drug costs or where they can purchase less expensive medications. Free samples were considered helpful, but only as a short-term solution, as patients given free samples did not have their medication regimen altered to provide for lower ongoing costs.
Participants in this study were recruited by their interest in receiving free web service and agreed to respond to questionnaires via the Internet. The authors point out that this method of data collection excludes a large number of potential participants, in particular, those with low-incomes. However, this is likely to mean that the number of patients with chronic illness underusing medication is higher than the study findings, and supports the conclusion that a lack of open communication with physicians regarding the ability to pay for healthcare costs can be dangerous.
How Does This Affect You?
Healthcare costs are rising at an alarming rate. A large number of people in the US have no health care coverage at all, and those that do have health insurance find themselves struggling with steadily increasing premiums. Additionally, a current trend among health insurers is to shift more costs onto patients. In a related editorial, Alex D. Federman states that many seniors have prescription drug costs that total more than 10% of their fixed income, despite the new Medicare prescription drug benefit plan. A report by the AARP on drug pricing found that from 2000 to 2004 manufacturers drug prices rose from 4.1% to 7.2%.
While no one can escape these rising costs, underusing or not taking medication for a chronic illness is not the answer, and in fact, can lead to higher health costs due to a worsening illness. A study that evaluated the underuse of medication in diabetes patients found that those patients who underused medication due to cost had more diabetic symptoms and less control over their illness.
Do not hesitate to talk to your doctor about how to afford your medications. He or she may be able to help reduce the cost of your care, for example, by prescribing less expensive generic drugs whenever possible. Additionally, doctors ought to raise these issues from the start, instead of incorrectly assuming that all of their patients have the means to follow recommendations at all costs. Don’t underestimate the importance of open and honest communication between you and your doctor. The success of your health care depends on it.
Information on Legislation and prescription drugs from the AARP
Federman AD. Don’t ask, don’t tell: The status of doctor-patient communication about health care costs. Arch Intern Med . 2004. 164: 1723-1724.
Piette J, Heisler M & Wagner TH. Cost-related medication underuse: Do patients with chronic illnesses tell their doctors? Arch Intern Med. 2004;164: 1749-1755.
Piette J, Wagner TH, Potter MB, Schillinger D. Medication underuse in diabetes due to cost. Med Care. 2004; 42: 102-109.
Rx Pricing continues to outpace inflation for the first quarter of 2004. Available at www.aarp.org/legislative/prescriptiondrugs/rxprices/Articles/a2004-06-29-inflation/. Accessed September 14, 2004.
Last reviewed September 2004 by
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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