Science + Technology

Medication Costs Infrequently Addressed When Newly Prescribed, UCLA Study Finds

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A new UCLA study hasfound that physicians discuss cost and aspects of obtaining newly prescribedmedications only about one-third of the time during patient/doctorinteractions.

But questions aboutpricing and prescription drug insurance coverage are critical — the high costsof drugs, including out-of-pocket payouts such as co-payments, are linked topatient non-adherence in maintaining their dosage schedules, said Dr. Derjung Tarn, assistant professor of family medicine at theDavid Geffen School of Medicine at UCLA and the study's lead author.

The study will appear in the November issue of The American Journal ofManaged Care.

"Though cost discussions are notalways necessary, especially if physicians know a patient's financial situationand the best formulary choice for a medication, physicians must have a highlevel of awareness about medication cost and issues impeding acquisition tomedication, because these can be important barriers to patient medicationadherence," Tarn said.

The researchers useda combination of patient and physician surveys and transcriptions fromaudio-taped patient visits at two Sacramento, Calif., healthcare systems fromJanuary to November 1999. They includeda total of 185 patients on outpatient visits with 15 family physicians, 18internists and 11 cardiologists. Some 243 new medications were prescribedduring these sessions.

Of the 185 patients,who had a mean age of 55 years, half were male, 83 percent were white, most hadhealth insurance and more than three-fourths paid less than half of theirprescription drug costs out-of-pocket. Family physicians saw 31 percent of thepatients, internists examined 47 percent, and cardiologists advised 23 percent.

The researchersfound that in only 33 percent of the cases did physicians prescribing newmedications communicate about issues related to medication acquisition such ascost, insurance, generic or brand name, logistics, supply and refills. Costsand insurance were covered 12 percent of the time, the logistics of obtaining medications18 percent of the time, and medication supply 9 percent of the time. Patientsinitiated discussions about costs or insurance in only 2 percent of the cases.

Discussions aboutcosts were likelier to take place when the patient earned less than $20,000 peryear compared with patients whose annual income topped $60,000, the researchersfound. Also, family physicians and internists were less likely thancardiologists to discuss costs, and physicians in general brought up the issueless when prescribing medications to older patients.

Other researchers onthis study in addition to Tarn are JohnHeritage, Ron. D. Hays and Neil Wenger, all of UCLA; and Debora A. Paterniti and Richard L. Kravitzof UC Davis.

The Robert WoodJohnson Foundation, the UCLA Specialty Training and Advanced Research (STAR)Program, the Health Resources Services Administration, the UCLA/DREW ProjectEXPORT, the National Institutes of Health, the National Center on MinorityHealth & Health Disparities, the UCLA Center for Health Improvement inMinority Elders/Resource Centers for Minority Aging Research, the NationalInstitute on Aging and the National Institute of Mental Health funded thisstudy.

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