Cost keeps many from taking their meds

Underuse of prescriptions is seen as an obstacle to quality health care.

By Andis Robeznieks, AMNews staff. Oct. 4, 2004.

Along with a database on drug interactions, Melvyn L. Sterling, MD, keeps a list in his handheld computer showing what local pharmacies are charging for the drugs he prescribes.

"I look at that and I tell patients which pharmacies are more or less expensive," the Orange, Calif.-based internist and chair of the AMA Council on Scientific Affairs said.

Conversations about the affordability of prescriptions are important, but they are also somewhat rare. According to a study in the Sept. 13 Archives of Internal Medicine, two-thirds of chronically ill patients 50 and older who underuse prescriptions to save money never tell their physicians about their intent in advance and 35% never discuss the issue at all.

While researchers said the study indicated a need for doctors to spend more time talking with patients, they said it also showed how physicians can use electronic medical records or work with a team of social workers, nurse-care managers, pharmacists and drug companies to help patients manage their prescriptions.

The study, funded by the Dept. of Veterans Affairs and the Agency for Healthcare Research and Quality, also showed how financial barriers add to the cost of care when chronic conditions are not managed and complications require hospitalization.

AHRQ spokeswoman Karen Migdail defined poor quality health care as the "misuse, underuse or overuse" of medications, treatments or procedures. By this definition, she said underusing prescriptions for financial reasons is definitely a quality issue. "People are not getting what they need."