Patients, Doctors Don't Discuss Rx Prices

Poll Shows Cost of Drugs Isn't a Factor in Doctor-Patient Discussions

By Todd Zwillich
WebMD Health News

Reviewed by Louise Chang, MD

March 17, 2009 -- Most patients never talk about price when getting a drug prescription from their doctor, and few confront the actual price of their drugs before it's time to pay at the pharmacy, according to a poll released by Consumers Union.

The group is urging doctors and patients to factor in the price of drugs when deciding on treatments. They're pointing to generics, which in many cases are just as effective and safe for the fraction of the price of a brand-name alternative.

"If cost is an issue, have a heart-to-heart with your doctor and make sure he or she knows that costs are an issue," says John Santa, MD, an internist and director of the Consumer Reports health rating center.

Consumers Union released a poll of roughly 2,000 adults showing that just 4% discussed price when getting a drug prescription from their doctor; as many as 60% of those polled learned about the price of their drugs for the first time at the pharmacy register.

The poll was conducted between Jan. 15 and Jan. 19; it has a margin of error of plus or minus 3.4 percentage points.

The poll confirms what many other studies have shown: that many patients regularly resort to measures such as cutting pills in half, skipping doses, or skipping medication altogether in an effort to save on medical bills.

"Sticker shock is really taking a toll on American consumers," says Ed Farrell, director of national research at Consumer Reports.

The magazine's latest issue has a guide to cheaper generics in about 20 drug classes, including drugs for high blood pressure, depression, and high cholesterol.

Comparative Effectiveness Research

Consumers Union is backing an Obama administration plan to boost research directly comparing the effectiveness of different drugs, devices, and other treatments. The hope is to find less-expensive treatments or tests that work as well as the more expensive versions.

Congress spent $1.1 billion in the economic stimulus bill to jump-start so-called "comparative effectiveness" research at the federal level.

But comparative effectiveness research -- or at least the way the government and insurers might use it -- is controversial.

Drugmakers, device manufacturers, and other industry groups worry that it could be used as an excuse to ration health care. They warn that the government and insurers could decide to pay only for the cheapest treatments, impairing the decisions doctors and patients can make.

Robert Moffitt, director of the Center for Health Policy Studies at the Heritage Foundation, says few are opposed to getting the best treatments for the best price. "Who the heck is against that?" he says.

"The issue is a federal infrastructure that will give a seal of approval about what to do," he says. He urges doctors and patients to have "a profound distrust" of how the research could be used as Washington tries to find a way to save hundreds of billions of dollars as part of overall health reform.

Sen. Tom Coburn, R-Okla., was also critical of the proposal. "They're going to look at cost, just like England does, and say, we can't afford it so we won't do it," he says. Coburn is a doctor and a member of the Senate Committee on Health, Education, Labor, and Pensions.

Policy makers have not yet decided how health programs like Medicare will use head-to-head research for drugs and treatments, or how the data will fit into overall health reform.

"The government has a real opportunity to provide neutral, credible, transparent public information for everybody to see," Santa says.

SOURCES:
National Poll, Consumer Reports National Research Center, March 17, 2009.
John Santa, MD, director, Consumer Reports health ratings center.
Ed Farrell, director, Consumer Reports National Research.
Robert Moffitt, director, Center for Health Policy Studies, Heritage Foundation.
Sen. Tom Coburn, R-Okla.
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