Patients may help their wallets by asking doctors how to safely lower out-of-pocket medical expenses.

Questions could include:

—Is there a lower-cost, generic version of the drug?

—Is this the least expensive drug in its class that’s appropriate for me?

—What other resources (such as pharmaceutical assistance programs or public aid) could help cover out-of-pocket costs?

—What other strategies (splitting pills, skipping doses, etc.) might be safe or risky?

Patients or doctors can ask such questions any time. Open communication about any health issue is recommended. It can’t hurt to let your doctor know what’s on your mind — and providers need to know if you’re skimping on pills to make ends meet.

Try bringing up the topic when the doctor reaches for his or her prescription pad, a new study shows.

“Physicians should develop the habit of using brief, just-in-time interventions at the point of prescription ordering that may reduce burdened patients’ out-of-pocket costs,” write researchers, who included the University of Chicago’s G. Caleb Alexander, MD, MS.

Out-of-Pocket Costs

About a fifth of health care expenditures are paid for by patients out of their own pockets. That amount has risen in recent decades, according to the study.

Drug costs matter to doctors and patients alike, but the topic doesn’t always get discussed. “Physicians often do not communicate with patients about out-of-pocket costs, although research indicates that physicians and patients value such discussions,” write the researchers.

It’s more than a financial issue. Patients facing high out-of-pocket medical costs sometimes cut corners, the researchers note. For instance, some people may split their pills or decrease doses to make their medicine last longer.

But disobeying doctors’ orders can be dangerous. Such measures could compromise patients’ safety and drugs’ effectiveness. When money is tight, how do doctors help their patients minimize drug costs?

Doctors’ Strategies for Drug Costs

To find out, the researchers sent surveys to more than 1,300 doctors nationwide. All participants were cardiologists or general practitioners; a total of 519 completed the surveys.

Cost concerns were widespread. Almost all doctors (93 percent) said they knew their patients in general were burdened by out-of-pocket costs. A similar number (91 percent) said doctors should consider out-of-pocket costs when writing prescriptions. Three out of four said they felt obligated to broach the topic when issuing a prescription.

However, those good intentions didn’t always translate into action. What’s more, only 36 percent said they knew how much money patients were paying for out-of pocket expenses.

What’s the Problem?

Doctors’ most commonly cited reasons for not bringing up the out-of-pocket expenses were:

—Lack of time (44 percent)

—Concern over possible patient discomfort (35 percent)

—Lack of habit (34 percent)

When trying to lower patients’ drug costs, doctors’ most common strategies were (in order of likelihood):

—Switch the patient from a brand-name to a generic drug. According to the researchers, this method to lower prescription costs seems likely to be beneficial.

—Give the patient samples of the medication.

—Review patients’ medications and discontinue nonessential prescriptions.

—Switch the patient to cheaper brand-name drugs.

Less common strategies were:

—Prescribe higher doses and tell the patient to split tablets. However this may not be appropriate for some medications, such as long-acting or sustained release formulas. This can be technically difficult for some tablets.

—Refer the patient to a pharmaceutical assistance program.

—Recommend an over-the-counter medicine.

—Refer the patient to a public aid agency or social worker.

They were least likely to encourage patients to address their concerns to a different doctor involved in their care or do nothing.

Responses were similar for general practitioners and cardiologists.

Next Steps

More work should be done to see which approaches are the safest and most effective, researchers write.

Meanwhile, the topic “may be an important yet neglected aspect of clinical practice,” write the researchers. The study appears in the Archives of Internal Medicine’s March 28 edition.

By Miranda Hitti, reviewed by Brunilda Nazario, MD

SOURCES: Alexander, G. Archives of Internal Medicine, March 28, 2005; vol 165: pp 633-636. News release, JAMA/Archives.