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Many chronically ill patients don't tell their doctors that they limit use of prescription drugs because of cost

Patients who are concerned about out-of-pocket medication costs often restrict their use of prescription drugs, according to a recent study. In addition, the study revealed that about two-thirds of chronically ill adults who cut back on their medications because of the cost don't tell their doctors in advance. The study was cofunded by the Agency for Healthcare Research and Quality (AHRQ grant HS10281) and the Department of Veterans Affairs (VA).

John D. Piette, Ph.D., and his colleagues from the Center for Practice Management and Outcomes Research at the VA Ann Arbor Healthcare System surveyed a panel of 4,055 adults age 50 and older who reported taking prescription medication for diabetes, depression, heart problems, or high cholesterol. Of these, 660 patients reported forgoing some medication in the prior year due to cost pressures, and two-thirds of this group reported that they did not tell their clinicians in advance. Approximately 35 percent of the 660 patients said that they had never discussed medication costs in the prior year with their clinicians.

The researchers found that most patients who failed to talk with their clinicians about medication costs said that none of their providers asked them about possible problems they might have in paying for their treatment. Patients also reported that they didn't think their clinicians would be able to help them with this problem, or that they were too embarrassed to discuss issues related to cost with their clinicians.

Most patients who did discuss the cost of prescription medication with their clinicians found their clinicians to be helpful and received various forms of assistance such as free samples or a change in their regimen to a less-expensive or generic alternative. However, less than one-third of the patients who spoke to their clinicians about the cost of prescription drugs reported that they had been given information about programs to assist patients with medication costs or sources of lower cost refills.

More details are in "Cost-related medication underuse: Do patients with chronic illnesses tell their doctors?" by Dr. Piette, Michele Heisler, M.D., M.P.A., and Todd H. Wagner, Ph.D., in the September 23, 2004, Archives of Internal Medicine 164, pp. 1749-1755.

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