Medication costs infrequently addressed when newly prescribed, UCLA study finds
A new UCLA study has found that physicians discuss cost and aspects of obtaining newly prescribed medications only about one-third of the time during patient/doctor interactions.
But questions about pricing and prescription drug insurance coverage are critical -- the high costs of drugs, including out-of-pocket payouts such as co-payments, are linked to patient non-adherence in maintaining their dosage schedules, said Dr. Derjung Tarn, assistant professor of family medicine at the David Geffen School of Medicine at UCLA and the study's lead author.
The study will appear in the November issue of The American Journal of Managed Care.
"Though cost discussions are not always necessary, especially if physicians know a patient's financial situation and the best formulary choice for a medication, physicians must have a high level of awareness about medication cost and issues impeding acquisition to medication, because these can be important barriers to patient medication adherence," Tarn said.
The researchers used a combination of patient and physician surveys and transcriptions from audio-taped patient visits at two Sacramento, Calif., healthcare systems from January to November 1999. They included a total of 185 patients on outpatient visits with 15 family physicians, 18 internists and 11 cardiologists. Some 243 new medications were prescribed during these sessions.
Of the 185 patients, who had a mean age of 55 years, half were male, 83 percent were white, most had health insurance and more than three-fourths paid less than half of their prescription drug costs out-of-pocket. Family physicians saw 31 percent of the patients, internists examined 47 percent, and cardiologists advised 23 percent.
The researchers found that in only 33 percent of the cases did physicians prescribing new medications communicate about issues related to medication acquisition such as cost, insurance, generic or brand name, logistics, supply and refills. Costs and insurance were covered 12 percent of the time, the logistics of obtaining medications 18 percent of the time, and medication supply 9 percent of the time. Patients initiated discussions about costs or insurance in only 2 percent of the cases.
Discussions about costs were likelier to take place when the patient earned less than $20,000 per year compared with patients whose annual income topped $60,000, the researchers found. Also, family physicians and internists were less likely than cardiologists to discuss costs, and physicians in general brought up the issue less when prescribing medications to older patients.
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Other researchers on this study in addition to Tarn are John Heritage, Ron. D. Hays and Neil Wenger, all of UCLA; and Debora A. Paterniti and Richard L. Kravitz of UC Davis.
The Robert Wood Johnson Foundation, the UCLA Specialty Training and Advanced Research (STAR) Program, the Health Resources Services Administration, the UCLA/DREW Project EXPORT, the National Institutes of Health, the National Center on Minority Health & Health Disparities, the UCLA Center for Health Improvement in Minority Elders/Resource Centers for Minority Aging Research, the National Institute on Aging and the National Institute of Mental Health funded this study.
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