Many who cut back on Rx drugs to cut costs don't tell doctors


Even though their health could suffer and assistance programs can help, 2 in 3 chronically ill patients stay mum

ANN ARBOR, Mich. Millions of Americans struggle every day to pay for their prescription medicines, often cutting back on how often they buy or take some of their drugs to save money. But a new study suggests that many of the sickest of these patients don't tell their doctors what they're doing -- even though skimping on certain drugs could harm their health and their physicians could help them.

The study's authors, from the Veterans Affairs Health Services Research Program, the University of Michigan and Stanford University, say their findings reinforce how critical it is for doctors and nurses to take the initiative in asking patients if they're having trouble paying for their drugs, and educating them about which ones are most necessary to protect their health. The researchers found that most patients who did speak up got help through free samples, generic drugs or information about assistance programs.

The study, published in the Sept. 13 issue of the Archives of Internal Medicine, finds that two-thirds of 660 chronically ill patients who had cut back on their prescription drugs because of trouble paying for them didn't tell their doctors before they did it. And even after they had started skimping, 35 percent never told their doctors.

All the patients surveyed had at least one serious medical problem, such as high cholesterol, high blood pressure, diabetes, heart disease, lung disease, osteoporosis or ulcers. And the vast majority of patients were on three or more prescription drugs when they started skipping doses or refills to save money.

"These chronically ill adults are the patients who most need their medications. Yet their doctors don't know that they aren't taking them because of cost pressures," says lead author John Piette, Ph.D., who holds positions at the VA Ann Arbor Healthcare System and the U-M Medical School. "As drug costs and the number of chronically ill Americans both continue to rise, it's essential that health care providers proactively discuss costs and adherence with their patients."

The patients were identified from a pool of nationally representative adults over age 50, but tended to be less educated and have lower incomes than average.

Those patients who didn't bring up the uncomfortable issue of cost weren't likely to get asked, either, the study shows. Two-thirds of those who had never talked with their doctors about their prescription cost problems said no one on their medical team had inquired if they were having any trouble paying for their drugs. More than half of these patients thought their doctors and nurses would not be able to help, and nearly half were embarrassed to raise the issue or didn't think it was important.

Non-white patients, and those with a high school education or less, were half as likely as respondents who were white or more educated to say that they had told their doctor before cutting back on drugs due to cost. But difficulties discussing medication cost problems were seen across all income levels, age groups and genders. Piette notes that this means health care providers should ask even their better-off patients if they're having trouble paying for their medicines or cutting back due to cost.

"This issue is important for all patients, especially those with conditions that can be controlled through regular use of medications," says Piette, a VA Career Scientist and associate professor of internal medicine at the U-M Medical School. "Other studies have shown that patients with chronic conditions and financial constraints are skipping such crucial drugs as diuretics, diabetes drugs, cholesterol drugs and antipsychotics, all of which are most effective with consistent use."

Piette and his colleague Michele Heisler, M.D., also of the VA Ann Arbor Healthcare System and U-M, recently published findings from another study that showed long-term poor health consequences among people who had reported cutting back on their medications due to cost. That study was the first to demonstrate such an effect by following the same population over time.

In the new study, the 65 percent of patients who did raise the issue of medication costs with their health care providers got help. More than 90 percent of these patients received free samples of medicines from their doctors. Sixty-nine percent got a new prescription for an equivalent, less-expensive brand name or generic drug, and 59 percent got advice about which medications they should definitely not skip. However, less than a third of patients received other forms of assistance, such as information about less-expensive sources for medicines or programs that could help them afford their drugs.

Piette and his colleagues note that free samples are not a sustainable solution to the drug cost issue. "Nearly half of the pharmaceutical industry's $12.7 billion annual promotion budget is spent on free samples, and these drugs are often the more expensive, newer medicines that boost company profits, but put additional strain on patients' financial resources when they have to pay for them," says Piette. "When alternative generic drugs are available, they often can reduce patients' costs over the long term while providing equivalent clinical benefit as the brand-name versions."

Piette also notes that an array of government and private-sector assistance programs are now available to help people with drug costs, and urges physicians to help patients find one that can help. Only about 10 percent of the patients in the survey who raised the issue of cost got a referral to a social worker or other professional who helped them. These allied health professionals could be invaluable in helping patients lower their medication cost pressures without putting all of this responsibility on busy primary care doctors and nurses, Piette adds.

"The bottom line for patients is: speak up or you might miss a great chance to get help. Don't wait for your doctor to ask you if you're having any problems paying for medications," he says. "And the bottom line for doctors and nurses is: don't be shy about asking your patients if they can afford the drugs you're prescribing, educating them about the importance of sticking to the ones that can help them most, and encouraging your patients to speak up if they have trouble paying down the road."

The survey data used in the study came from a national panel of adults compiled by Knowledge Networks, which tallies information on health, economic and demographic characteristics of a statistically representative cross-section of Americans. The initial sample used to identify the survey respondents for the study was 5,644 adults aged 50 and older who reported taking prescription medications for diabetes, depression, heart problems, hypertension or high cholesterol. Of the 4,264 who responded to the survey about drug costs, 660 who reported at least one episode of cost-related drug under-use in the last year were asked in detail about that issue.

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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