Medication cost may be root cause of nonadherence: ask your patients

OB/GYN News,  Oct 15, 2003  by Mary Ellen Schneider

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One way to improve drug adherence is to ask patients if they have skipped or cut down on their prescribed medications because of cost, said Dr. Ethan A. Halm of the department of health policy at Mount Sinai School of Medicine in New York.

The underuse of medicine due to cost is a more common reason for poor disease control than is appreciated, Dr. Halm said. Dr. Halm and his colleagues recently published a study based on an educational invention aimed at raising awareness among physicians about how much their patients pay for drugs (J. Gen. Intern. Med. 18[1]:31-37, 2003).

To learn more about the impact of out-of-pocket drug costs on patient compliance, Dr. Halm and his colleagues gave internal medicine house officers and attending physicians at four teaching hospitals in New York City and northern New Jersey a pocket guide with the average wholesale prices for more than 100 drugs commonly used in primary care. They also hosted lunchtime conferences to educate participating health providers on issues that can occur when patients can't afford to take their medicines.

The educational program included information about insurance coverage of prescription drugs. Although it's impossible for physicians to remember the ins and outs of every formulary, they should have an idea of what patients face when going to the pharmacy, Dr. Halm said.

The program also emphasized that generics can be significantly cheaper and are available for most common diseases. The program highlighted examples of the differences in a patient's drug bill based on the physician's prescribing choices.

"Cost isn't the only thing that's driving a prescribing decision," Dr. Halm said. In some cases the newer, brand-name drugs may be the best fit for the patient but cost should be a factor in the decision making, he said.

But one thing a physician can do to improve some patients' drug adherence is simply to talk to the patient. When a patient's disease is not well controlled, ask if he or she has cut, skipped, or missed any medications due to cost. Or ask how he or she pays for prescriptions, Dr. Halm said.

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