Should doctors discuss cost with patients?

A recent poll conducted by the Consumer’s Union, publisher of Consumer Reports, found that only 4 percent of patients said their doctors talk with them about the cost of prescriptions. And 60 percent find out what the price is for the first time when they pick up their drugs at the pharmacy.

Should doctors discuss the price of medication before prescribing it?

As physicians, we’re trained to make treatment decisions without the influence of money or insurance companies. We should be guided by what is in the best interest of the patient’s health, not by the patient’s ability to pay.

But particularly during a recession like the one we’re in now, when people are losing their jobs and health insurance – patients come up with their own ways of saving money on health care. They’re reluctant to pay for preventive care, and they do things like cut pills in half to make them last longer, skip doses, or stop their drug regimen altogether.

Combine this with the rising cost of patients’ health care deductibles, and it’s more important than ever that we start discussing costs with patients. Doctors need to be more pro-active about educating ourselves about costs. Those conversations may help ensure that our patients can and will take care of their health.

If I didn’t cover your issue, you can add it in the comments, or call into the ReachMD Listener Line at 888-639-6157 and record your comments (portions of which may air).

I encourage you to listen and vote in this week’s poll, located in the upper right column of the blog.

Please suggest future ReachMD Poll topics by emailing Poll@ReachMD.com.

Comments

Lizzie
Yes! Get out of the bubble. The cost of clinic visit co-pays & prescriptions can impact so many other decisions. That $50 non-formulary prescription cost is half my food budget for the month. The $25 or $35 (sometimes more) co-pay (if she/he even has insurance) from the patient could mean not getting enough to eat that week – or not being able to fill up the car with gas. Both have happened to me.
Docs are in a position of trust. They’re the ones with the knowledge. I don’t want to second guess their recommendations – but really they need to understand that their decisions about prescriptions and follow-up care have a real impact on many of their patients’ finances. I believe they have some responsibility to their patients in this regard. How and to what extent I cannot say. I don’t know how you broach the subject or even identify a patient who may be at risk financially. Perhaps having a basic understanding of the cost of medications is a place to begin.
I can tell you that I changed doctors because of money. I was being seen at a university hospital in an outpatient center. I had carefully budgeted to be able to afford the co-pays. The University Hospital messed up the billing for nine months. – When they finally got it right I was on the hook for another $500 in “facilitity fee” co-pays because I was seen in a “hospital-based” outpatient clinic in a teaching hospital. The Univ. is allowed to charge a second co-pay for each and every visit. By their mistake going on for so long I was unable to manage my finances the way I should have. If the billing had been done correctly I would have known the first month I couldn’t afford to continue with those physicians.
The physicians and their staff in the outpatient center didn’t understand themselves what it meant – and didn’t explain to me (and their other patients) what seeing them in their clinic meant financially. The claim that the information is disclosed on the consent for treatment form that the patient signs is bogus – it’s unclear (I am highly educated and comprehend the written word quite well) and buried in a lot of other language.
I think the hospital knows that it would lose a certain amount of business if patients knew beforehand that there is an added cost in being seen at the University Hospital outpatient clinic. There’s a touch of fraud in it, in my opinion. Perhaps not legally, but morally.
Doc Stone
Doctors should make treatment decisions without the influence of their own financial self-interest. That does not mean that the patient’s financial interests should not be a consideration. It would be absurd for example to recommend a treatment that costs 300$ a month to a patient who in passing offers a complaint of a benign minor discomfort, who takes a week of his labor to earn that 300$. It might be a reasonable suggestion to make to someone who takes one hour to earn it. The doctors who does not make himself aware of and consider his patients financial situation will do some of his patients a disservice.
Good medicine means treating the whole person. That includes the person who worries about paying his bills, suffers shame for not doing so or asking for charity, or who deprives his family of other necessities to pay for the “very best” treatment–when second best is 98% as good and costs 10% as much. Worry, shame, fatigue from overwork–those are forms of suffering also and deserve the physician’s consideration.
Anonymous
Sometimes, the financial aspects make a difference in quality of life. For example, if treatment A costs has an 80% chance of working while costing an amount affordable to the patient, while treatment B has an 85% chance of working while costing a much larger amount that could put the patient in heavy debt for the rest of his/her life (perhaps leading to constant worry and stress, and perhaps inability to afford other medical treatment including preventive care), wouldn’t it make sense to present both options to the patient?
ray
It may interesting for patients to know that the doctors have no clue of the costs involved and several private doctors prescribe very expensive medications because the pharmacy reps detail them on latest meds. Rarely do I see a doctor who looks at the whole picture and says there is a smarter why to treat the same condition. Patients trust their doctors and doctors need to step up to help in this process, they need to focus this during the training years.
Jenn
My docs are very good about covering price topics in discussions. They generally start with “What insurance do you have?” when speaking of tests or “Does your insurance cover prescriptions?” for new meds. In the case of my son’s medications (he does NOT have insurance yet) he is willing to take cost into consideration when choosing medications but not at the expense of choosing the right med. Instead he has his office staff familiar with the medical assistance programs the companies offer and set us up with them.
If the docs are not willing to discuss price, they MUST understand that they are creating another barrier to patient compliance. In my situation, given the choice between not getting my meds and not making my hose payment, I will skip the meds. In the choice between my meds or my son’s, I will choose his every time.
We WANT to follow your instructions, but sometimes we must make tough choices. Knowing this and taking it into consideration will help both parties.
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family doc
I try hard to use generics, avoid ordering expensive tests unless necessary, and not waste my patients money. However, it is impossible for us physicians to keep track of all of the payers and drug plans’ complicated rules. .
What is inexpensive for one patient’s plan is costly for another. Some payers cover items that are “preventive” better than items for medical problems, other payers do the opposite. Within a single payer and drug plan combination, the rules change frequently, last year’s low copay drug is this year’s high copay drug.
If, like most patients, you’re stuck with a third party payer calling the shots (instead of you and your physician), then learn the rules of your payers. Don’t rely on your physician to keep track of this for you, we simply can’t.
Don’t expect it to get better as commercial payers abandon the market to the government. Complicated sets of rules are needed by third party payers to keep physicians and patients from easily spending the payer’s money on expensive treatments, whether the payer is commercial or government. Medicare and Medicaid are among the worst already.
stargirl65
I try to prescribe generics whenever possible. Sometimes this is not possible though and a more expensive medicine is needed.
The multitude of pharmacy benefit managers(PBMs) have made it impossible for me to keep up with things. Even some generic drugs cost patients a lot of money or have limits on the number of pills the patient can get at one time. I have no access to this information for any one particular patient. Also a medicine that is cheaper on one plan is outrageous on another plan due to behind doors deals these plans make with pharmaceutical companies. With over 50 plans for me to comply with, that are always changing, it is impossible for me to do.
The patient needs to participate in this. Many plans send lists of preferred drugs to patients. The patient can bring this to the visit and I will attempt to use drugs off it if appropriate. Also I use the low cost medicines from Walmart and Target as well.
I cannot help a patient though if they don’t speak up during their visit.
http://Www.helixhealth.org Steven Murphy MD
I always let patients know the cost of things. Otherwise patient think a complete physical costs 20 bucks rather than the several hundred I bill. I also keep patients finances in mind when prescribing medications. That is patient centeredness.
Steve
-www.thegenesherpa.blogspot.com
http://dikku@fuse.net richard cardosi
Many patients in the ER are insulted when I mention the cost of a test or a procedure. It is as if the mere discussion of cost is taboo. Their main focus seems to be to do everything available. Of course most have no understanding of sensitivity and specificity,false postives and false negatives. I therefore limit my discussion to risks of radiation exposure and waiting times. The public seem to think that more tests equals better care. I for one know that is not true but feel in a bind to order more tests to cover myself in case of an atypical presentation and to be able to defend myself if there is a bad outcome.
dick

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