Be frank with patients about prescription drug costs

Commentary. By Charles Atkins, MD, AMNews contributor. March 12, 2001.

COMMENTARY

Observations on the state of medical practice and medical life

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Last week I took an older friend to see her physician. Afterward we stopped at the pharmacy to fill her prescriptions. Like many older Americans, she depends on Medicare but does not have supplemental coverage to pay for medication. The bill astounded me.

She took it in stride, and made decisions about which ones to fill and which to do without. Later, I received a phone call from another friend who was fuming over a $500 bill for a 60-day supply of two medications, "and that's with a 30% discount!"

As often happens, seeing something through others' eyes was enlightening. When I began my career as a psychiatrist, I worked exclusively with a geriatric population. A common question as I pulled out my prescription pad was, "How much will this cost?" Initially, I had no clue.

However, a couple years of phoning pharmacists and getting quotes on pills alerted me to the fact that my patients couldn't afford much of the medication I was prescribing. It's a real eye-opener to make a list of your top 10 drugs and then cost out a year's supply. For me this involved looking at newer antipsychotics that ran between $3,000-$8,000 and antidepressants that weren't far behind.

I realized that if I didn't take this into account, my patients would have to make choices based on what they could afford. In the case of individuals with serious mental illness, a wrong decision could be catastrophic.

Unfortunately not all pills are created equal, and the older, less expensive and available-as-generic medications may have higher incidences of side effects, or just not be as efficacious as the newer drugs. This is clearly the case in psychiatry. As I chat with my colleagues in other specialties, I believe the same holds true. Research has moved ahead and many of the old standbys don't cut it. [...]