|A Lapse in Communication
A rather disturbing survey done by Consumer Reports shows Americans are increasingly skipping their medications, cutting doses, and failing to fill a prescription entirely. That number stands at 48% of those surveyed, up 9 points from 2010. The problem is partly the recession but also a lack of communication between doctor and patient at the time of the prescription being handed out.
Only 5% of patients knew the cost of the prescribed drug at the time the doctor wrote it. Another 64% found out when it was dispensed at the pharmacy. That is like ordering meals without seeing prices on the menu. No wonder many patients suffering from declining incomes and investments take steps that could endanger their health. It points out that doctors and patients are not properly communicating. Writing a prescription requires, in my view, that the doctor be aware of the cost to the patient and at least give a ballpark estimate. I know each insurance plan is different in what it covers and that doctors would need to do some extra work to tell a patient what it costs.
Patients who cannot afford a drug will take more risks in how they use it. Clearly there has to be a better way. Patients incorrectly dosing are a hospitalization waiting to happen. Drug companies have compassionate use discounts for the poor but this seems to be a problem extending in the middle class range of income. One would think physicians could prepare hand-outs to patients with approximate average cost at retail to patients. Physicians under our current system are totally separate from the selling of drugs. Most only have a vague idea of the patient cost.
When I lived in Japan in the 1990’s, physicians sold the drugs they dispensed. Of course this practice is problematic for conflict of interest reasons. I never left a doctor’s office in Japan without getting a prescription. I did, at least, know the price. Surely in America, we can better educate patients at the doctor’s office what their pharmacy bill will be. Maybe the receptionist/check-out person can make that a practice to look up the retail price or formulary coverage. Maybe they can hand the patient a price guide or drug companies can print up drug price ranges on a card.
Certainly compliance and retention are huge problems and they have been for a variety of reasons. Some patients do not like the side effects, or do not think they need a prescribed pill because their condition is asymptomatic. Here, however, we should not accept sticker shock as an acceptable reason of non-compliance. It seems more communication is the answer and even busy doctors owe patients more price information.