“Follow your doctor’s orders!” That’s what most of us have been told since we were kids, haven’t we? That sage advice seems to apply with particular emphasis when it comes to taking prescription drugs – we’re always reminded to take every pill on time, since our good health depends on it.
Given that cultural background, we were surprised and a bit dismayed as we read this recent article from HealthDay in which reported Steven Reinberg reveals recent data which shows roughly one senior in five either rationing their medications or skipping them entirely. This behavior isn’t due to carelessness or forgetfulness, says Reinberg – it’s due to finances. These seniors, even though they have Medicare coverage, are skipping their meds because they can’t afford the cost.
We suggest that, in the world’s richest country, this is a disgrace. Let’s read on and see what HealthDay is reporting.
Research Reveals Financially-Strapped Seniors Skipping Meds
In a new U.S. study, researchers found that roughly 20 percent of older adults reported taking less medication than they were prescribed, or not taking their medication at all, due entirely to cost, according to HealthDay’s Reinberg.
For the study, researchers surveyed more than 2,000 men and women age 65 and older, both over the phone and online. The report of the study was published online May 18 in JAMA Network Open.
Along with skipping or rationing medications, other cost-based behaviors were noted. Stacie Dusetzina, lead researcher on the study and professor of health policy at Vanderbilt University, explains, “We also found that most respondents wanted to talk with their doctors about medication costs and would want their doctor to use tools to estimate their medication prices if they were available.” But too often, doctors aren’t providing that kind of basic support.
Going Into Debt, Scrimping on Basics
Reinberg writes, “Among those taking part in the survey, 20 percent said cost prevented them from adhering to their prescription drug regimens. Nearly 9 percent said they skimped on basic needs to afford their medications and nearly 5 percent said drug costs made them acquire debt.” When you consider the number of seniors in the U.S., that 5 percent represents nearly 3 million people.
The statistics are nearly unanimous when it comes to communicating with health professionals about drugs costs. Reinberg explains, “89 percent [of respondents] said they were comfortable or neutral about being screened before a doctor visit for having a medication cost conversation and nearly 90 percent said they would like it if their doctor used a tool that would alert them to the cost of drugs.” Instead, all too often the actual cost doesn’t become clear until the patient is standing at the pharmacy counter.
On the Edge of Affordability
Of course, it’s all well and good for doctors to give patients a drug cost estimate, but the big fear revealed in the survey appears to be a worry that those cost figures might be inaccurate. Respondents disliked the notion of paying more than their doctor estimated. “In fact,” Reinberg writes, “80 percent said that if the costs were higher, they would have to assess their decision to take the drug, the researchers found.”
And Dusetzina’s team also found that many patients expressed that they would be “upset” if their doctor did not disclose or discuss the cost of a drug with them, especially if they already knew it. In our view, this reluctance on the part of doctors to discuss drug costs reflects a lack of empathy with the patients who have to shell out deductibles and co-pays for prescriptions.
“I wish I could say I was surprised, but the reality is this is the kind of finding that we’ve seen in other work, and it’s the kind of finding that practicing clinicians see every day,” said Dr. Adam Gaffney, who wasn’t involved with the study. Gaffney is an assistant professor of medicine at Harvard Medical School in Boston and an outspoken advocate for extending Medicare to everyone.
Co-Pays, Out-of-Pocket Costs Drive Drug Expense Higher
Gaffney goes on to explain that the high cost of drugs really boils down to copays and out-of-pocket costs. “Copays, coinsurance, deductibles can be quite high, even if you have a Medicare Part D drug plan,” he says. What’s more, seniors aren’t the only ones feeling the pinch. “I don’t think this is a problem [of] just of the over-65 population. In fact, I think if you look at a privately insured population that was younger, you might have actually had the same adverse results.”
New drugs that are still patented have a reputation for particularly high out-of-pocket costs, but some generic drugs have also been caught up in the tide of steadily rising drug prices.
“We know that these price increases are reflected in what people are paying when they go to the pharmacy,” Gaffney says. “We know that that often will lead patients either leave the prescription behind or not even fill it at all, or make other sacrifices.”
Doctors Clueless About Costs to Patients
Perhaps most frustrating of all, Gaffney admits that most doctors don’t actually know the prices that patients have to pay for drugs.
“As a physician, you want to know what the out-of-pocket costs were ahead of time,” he says. “You want to know what that meant for the patient. So, I think that sort of informational kind of infrastructure could have some benefits. But I think what that doesn’t help you with is the fact that ultimately you want to be prescribing drugs that are best for the patient.”
Reinberg explains that there are programs accessible to some patients that may lower out-of-pocket costs. “These include Medicare programs, private companies that may help lower costs on some generic drugs, and drug companies that often have special programs to make new drugs more affordable,” he writes. But finding these savings can be extremely challenging.
Solution May Require “Systemic Change”
Ultimately, Gaffney and his colleagues believe that solving the problem of high drug prices is going to require a cultural and institutional shift. His hope is that, someday, all drugs will be free for those who need them.
“Things can happen in the physician’s office, but at the end of the day, what we need is systemic change,” Gaffney says. “There is a growing appetite for really reforming the system because there’s just something not civilized about having people go without necessary medications simply because they can’t afford the copay.”
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(originally reported at https://consumer.healthday.com)