Issued 5/13/04 by the American Journal of Medicine press office

Do health care providers ask you whether you can afford the prescription? In a study published in the current issue of The American Journal of Medicine, researchers from the Department of Veterans Affairs/University of Michigan, the Michigan Diabetes Research and Training Center and Stanford University found that only about 25% of patients who were having difficulties with prescription costs were even asked if they were having trouble paying.

High out-of-pocket medication costs can cause patients to underuse medications, leading to adverse health outcomes, increasing use of acute health care services, and forgoing other necessities to cover costs.

The cross-sectional, national survey covered 4,050 adults aged 50 years or older who use prescription medications for at least one of five chronic health conditions. Of these, 1,499 respondents reported problems paying for a prescribed medication and only 360 (24%) of those patients recall being asked by their clinicians if paying was a burden.

Writing in the article, Michele Heisler, MD, MPA, Center for Practice Management and Outcomes Research, VA Ann Arbor Health Care System, Michigan, states, "Despite the scope and severity of the problem, little is known about whether health care providers are effectively identifying patients who experience burdens associated with prescription medication costs. Identifying such patients would enable clinicians to better help these patients make informed decisions about how to manage their health conditions in the context of financial constraints, for example, through assistance programs or, when possible, use of less expensive treatment alternatives."

The study also found that African American and other race/ethnic minority patients were significantly more likely than white patients to be asked about possible financial hardships. Dr. Heisler continues, "In light of research documenting the ways in which stereotyping and other biases may influence physicians’ treatment decisions for African Americans and other minorities, our findings suggest that providers may be making racially based assumptions about patients’ ability to pay, as well as their possible medication adherence. Whether this is indeed the case, and whether such assumptions contribute to ethnic disparities in prescribing effective but expensive treatments, needs to be explored in future studies."

The study is reported in “Clinician Identification of Chronically Ill Patients Who Have Problems Paying for Prescription Medications" by Michele Heisler, MD, MPA, Todd H. Wagner, PhD, and John D. Piette, PhD. The article appears in The American Journal of Medicine, Volume 116, Number 11, published by Elsevier.

Full text of this article is available upon request. Contact ajmmedia@elsevier.com to obtain a copy or to schedule an interview.

© 2004 The American Journal of Medicine. All rights reserved. Unauthorized use prohibited.

The American Journal of Medicine, known as “The Green Journal,” is one of the oldest and largest general internal medicine journals published in the United States. The information contained in this article in The American Journal of Medicine is not a substitute for medical advice or treatment, and the Journal recommends consultation with your physician or healthcare professional.

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