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Costs Cause Many to Curtail Medications

Most patients don't tell doctors they can't afford drugs

MONDAY, Sept. 13, 2004 (HealthDayNews) -- Many Americans are not taking all their medicines because they can't afford them, and most aren't telling their doctors about it, new research shows.

"In a survey of 660 patients who had cut back on their medications because they could not afford them, the majority didn't tell their physicians," said lead researcher John Piette, a career scientist at the Veterans Administration Ann Arbor Healthcare System.

Piette's team focused on chronically ill patients over 50 who had cut back on their medications in the past year, according to their report in the Sept. 13 issue of the Archives of Internal Medicine.

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

The researchers found that two-thirds never told their doctors they planned to scrimp on their medications because they cost too much. "One out of three never told anyone at all that they were taking less medication because they couldn't afford it," Piette said.

This finding was unexpected, Piette said. "I think this will be a surprise to doctors. If a large number of patients are taking less medication than the doctor thinks they are taking, doctors are not able to make appropriate treatment decisions," he added.

Many patients were embarrassed to talk to their doctor about medication costs, Piette said. In addition, 58 percent didn't think their doctor could help them solve the problem.

However, when patients did talk with their doctor about the ability to afford medications, 72 percent found the conversation helpful. But even then, 31 percent never had their medication changed to generic or less expensive drugs and were not told about programs that could help them pay for their medications, the researchers report.

"The most common thing doctors did was to give patients free samples of medication," Piette said. "That can be very helpful in the short term, but is not necessarily a long-term solution."

Cost of medications is a very clear barrier, Piette said. "Physicians and patients have been frustrated with this issue, but there are many things that physicians can do that can make the situation better," he said.

Piette believes that once doctors understand the patient's problem, they can devise plans that will change medications, establish which medications are essential, and help patients understand the medications they are taking and why they are important.

In addition, doctors can switch medications to less expensive ones, change doses, or refer patients to programs that can either help pay for drugs or provide options for buying medications as cheaply as possible, Piette said.

"If you are having trouble paying for your medications, you should raise that issue with your physician," Piette said. "Don't wait for your physician to ask you, because there are things your provider can do to help you have a medication regimen that both protects your health and is financially something you can afford," he advised.

"This is an issue that is not often discussed between doctors and patients," said Dr. Alex D. Federman, an assistant professor of medicine from Mount Sinai School of Medicine in New York City.

But it should be, he added, because doctors may be able to help.

Federman, who wrote an accompanying editorial, said doctors can give patients information about programs that can help give them access to affordable medications. These programs include drug discount cards, state programs, and Medicaid medication programs. Doctors can also refer patients to social workers who can help identify programs to help offset drug costs.

Federman also noted the Medicare prescription program takes effect in 2006 and will help solve the problem for many patients.

"Patients need to talk with their doctors when they are having problems paying for health care," Federman said. "They should ask their doctors if there is some way the doctor can help them."

More information

Helping Patients.Org can tell you about programs to get cheaper medications.

SOURCES: John Piette, Ph.D., career scientist, Veterans Administration Ann Arbor Healthcare System, associate professor, University of Michigan Medical School, Ann Arbor; Alex D. Federman, M.D., M.P.H., assistant professor, medicine, Mount Sinai School of Medicine, New York; Sept. 13, 2004, Archives of Internal Medicine
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