Cost vs. compliance: Physicians encouraged to discuss prescriptions

Patients often fail to follow doctors' orders because they can't afford the medication. Talking with patients about money is one step toward changing that.

By Kevin B. O'Reilly, AMNews staff. April 23/30, 2007.

A 45-year-old woman with type 2 diabetes was showing some control of her hemoglobin A1c under the supervision of Virag Y. Shah, MD, but not as much as the Whittier, Calif., family physician would have liked. He decided to add pioglitazone, a thiazolidinedione marketed as Actos, to the patient's armamentarium. The woman's blood sugar levels did not drop after three months, so he upped the dosage. Another three months passed, and still nothing. To the contrary, the woman's glucose levels rose slightly.

"Are you taking the medication?" Dr. Shah remembers asking his patient.

"Not all the time," the woman sheepishly answered.

"How often are you taking it?" he asked. "Once a week? Every other day?"

"Well, less than that," she said.

"You're not really taking it at all," Dr. Shah said.

"Well, that's right," the woman answered.

"Did you fill the prescription?"

"No," she said. "It was going to be $180 a month because it wasn't covered. And I can't afford that."

With this new information, Dr. Shah could act. While there is no generic equivalent for Actos, he was able to start her on an insulin regime.

Unfortunately, the right treatment for Dr. Shah's patient was delayed because he did not initially discuss costs with his patient, and she was reluctant to bring up the matter.

The lesson Dr. Shah took away from this experience -- one borne out by the evidence -- is that patients' out-of-pocket prescription drug costs can play a big role in how well they follow doctors' orders.