AURORA, Colorado ― How often do you talk with patients about how to lower their out-of-pocket costs for medical care?
For most clinicians, the answer is: not often enough. But having those conversations can improve medication adherence and strengthen the patient-clinician relationship, according to panelists at the Society of General Internal Medicine (SGIM) 2023 Annual Meeting.
The inverse association between out-of-pocket expenditures and fidelity to prescriptions is clear. A 2020 study by the IQVIA Institute for Human Data Science, for example, found that rates of prescription abandonment are less than 5% when a given medication carries no out-of-pocket cost for patients. That figure rises to 45% when the cost is more than $125, and to 60% when it exceeds $500. One in five Americans said cost prevented them from adhering to medication regimens, according to a new study in JAMA Network Open.
The researchers surveyed more than 2000 men and women, 40.4% of whom were at least aged 75 or older. They found that nearly 90% of respondents said they would not be uncomfortable being asked about drug costs before a visit with a physician. A similar share (89.5%) said they would welcome the use by their physician of a real-time tool to determine the cost of their medication.
But the survey results contained a note of warning for clinicians: A significant number of respondents said they would be “extremely” upset if the cost of their medication exceeded the estimate from the pricing tool. And many also said they would be “moderately” or “extremely” angry if their physician used a pricing tool but failed to share the results with them.
“Real-time benefit tools may support medication cost conversations and cost-conscious prescribing, and patients are enthusiastic about their use,” the authors write. “However, if disclosed prices are inaccurate, there is potential for harm through loss of confidence in the physician and nonadherence to prescribed medications.”
While having conversations about cost can be difficult for both clinicians and patients, studies have shown that patients who discuss cost concerns with their doctors feel as if they have stronger relationships as a result.
Clinicians often avoid conversations about out-of-pocket expenses because they don’t know specific price information, they lack solutions to address cost, or they are uncomfortable bringing up the issue.
One member of the audience at the SGIM meeting recalled a patient who worked in a warehouse for a large company. The man, who had type 2 diabetes, had medical insurance, but even with insurance, insulin was going to cost him $150 per month. He struggled to afford the necessary treatment.
“He looked at me and said, ‘What do they want me to do? Do they want me to actually not be able to work for them and not manage my diabetes?’ “
The clinician said he offered empathy in the moment but felt he could do little else.
Panelists acknowledged that clinicians are crunched on time when seeing patients, but being willing to initiate conversations about cost with patients and to offer resources can help patients get necessary treatment.
Start the Conversation
Panel member Caroline Sloan, MD, an assistant professor of medicine at Duke University School of Medicine, in Durham, North Carolina, said making patients aware that you know cost can make a big difference.
Dr Caroline Sloan
The American College of Physicians advises clinicians to ask patients whether they are worried about the cost of care and to not assume which patients may have concerns.
The conversation could be started like this: “I’d like to discuss any concerns you might have about the cost of your healthcare.”
Normalize the concern by making it more general, and reassure your patient that your goal is to get them the best care. Say something like, “I’ve heard from many patients the cost of medications or tests is becoming hard to manage.”
Once a patient’s concerns are clear, you can direct them to resources for assistance in reducing their costs, Sloan said (see below).
Sloan said she knows clinicians don’t have time to understand every insurance plan and other issues related to cost. “But at least know to ask about costs,” she said. “Practice, practice, practice. It feels awkward at first, but it gets easier every time.”
What it does: This website serves as a cost estimator for inpatient, outpatient, and dental care.
What it does: A cost estimator for inpatient, outpatient, and dental care.
What it does: A cost estimator for inpatient and outpatient care, medication, and dental care.
New Choice Health
What it does: A cost estimator for inpatient and outpatient care and insurance.
Resources for Drugs and Medicines
What it does: Searches for the lowest price of a prescription and provides links to relevant patient assistance programs or available coupons.
What it does: Lists drug prices from online pharmacies in the US and other countries.
Resources on Copayments
What it does: This nonprofit organization helps uninsured patients with copays, premiums, deductibles, and other out-of-pocket expenses.
Patient Advocate Foundation
What it does: Helps qualified patients pay for prescription drug and treatment copays.
What it does: This nonprofit organization helps patients with qualifying medical conditions pay for treatments and medical care.
Resources for Medical Supplies
Good Health Will
What it does: Provides used medical equipment at reduced prices.
Resources for Transportation
Mercy Medical Angels
What it does: Provides ground and air transportation to patients in need.
American Association of Family Physicians Neighborhood Navigator
Website: aafp.org/patient-care/social-determinants-of-health/everyone-pro-ject/neighborhood-navigator.html or search for AAFP Neighborhood Navigator
What it does: Enter a ZIP code, and this website will find help relate to physical and mental health, food, transportation, work, finances, and education.
Society of General Internal Medicine (SGIM) 2023 Annual Meeting: Presented May 11, 2023.
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