Abstract
Background: Many Medicare beneficiaries face substantial out-of-pocket prescription drug costs under Part D. Providers may be able to help patients make clinically appropriate choices when they have concerns about drug costs. We examined patient-provider cost discussions during the first year of Part D benefits.
Methods: We conducted telephone surveys in early 2007 in a stratified random sample of Part D beneficiaries of a large integrated delivery system (n=1040, response rate=74.9%). Patients reported whether they talked with a doctor, engaged in any cost coping behavior (e.g., switched to a cheaper medication, split pills with their doctor’s advice), reduced adherence (e.g., stopped refilling a prescription) or experienced financial burden (e.g., went without another necessity) because of their drug costs in 2006. We used multivariate logistic regression to examine characteristics associated with talking with a doctor about costs and the association between discussions and cost responses. All analyses were weighted for differences in sampling proportions.
Results: Overall, 15.6% reported discussing drug costs with a doctor: 11.7% of patients who did not reach the coverage gap (‘doughnut hole’), and 32.6% of those who did. Among patients who talked with their doctor, 80.0% initiated the discussion and 62.6% felt their provider was helpful. In conjunction with these discussions, patients most frequently reported that their doctor switched a prescription to a less expensive version (46.1%), talked to them about which medications should definitely not be skipped (32.0%), and asked whether they could afford the medication before prescribing (26.5%). After adjustment for individuals’ drug costs and other characteristics, patients who talked with their doctor about drug costs were more likely to report each of the three types of cost responses compared with those who did not: cost coping behavior (OR=5.42, 3.05–9.61), reduced adherence (OR=2.96, 1.62–5.43), and financial burden (OR=3.01, 1.27–7.13).
Conclusions: In this study population, fewer than 1-in-6 patients discussed drug costs with their doctor, but the majority of those who did found their doctor helpful. Patients most frequently reported that their doctor switched them to a cheaper medication or advised them on the clinical necessity of their medications. There appears to be a strong association between patients talking with their doctor about costs and reporting behavioral responses to drug costs.
- Received September 11, 2008.
