Physician communication about the cost and acquisition of newly prescribed medications

To describe the frequency and content of physician discussions about the cost and acquisition of new medications.

Qualitative and quantitative study combining patient and physician surveys with transcribed audiotaped office visits from 185 outpatient encounters with 15 family physicians, 18 internists, and 11 cardiologists in 2 Sacramento healthcare systems between January and November 1999, in which 243 new medications were prescribed.

Transcripts were qualitatively analyzed to describe conversations concerning the cost and acquisition of new medication prescriptions, frequencies of discussions were described, and multivariate logistic regression was used to examine the predictors of cost discussions.

For one third of newly prescribed medications, physicians discussed an aspect of acquisition, including cost and insurance coverage for 12%, logistics of obtaining medications for 18%, and medication supply for 9%. Patients initiated cost or insurance concerns for fewer than 2% of the new medications prescribed. There were 5 discussions about patient out-of-pocket costs and 7 discussions offering tips for cost savings. In multivariate analysis, cost discussions were more likely to occur with patients earning less than 20,000 dollars per year compared with those earning more than 60,000 dollars per year, were less likely to occur with medications prescribed by family physicians or internists compared with cardiologists, and were less likely with medications prescribed to older patients.

Physician-patient discussions about new medication cost and other acquisition issues, especially medication affordability, occur infrequently. Because physicians may not recognize patients' financial impediments to acquiring medications, this issue should be raised when prescribing new medications.