One in five U.S. adults prescribed medicines say they’ve asked their doctor for a cheaper option, according to a new report from the Centers for Disease Control and Prevention.
Nearly 60 percent of U.S. adults said they’d been prescribed a medication in the past year, the majority of which come with out-of-pocket costs. The report looked at three ways adults who were prescribed medicines tried to cut costs in 2017: asking for a cheaper drug, not taking medicine as prescribed, or seeking alternative therapies. Strategies to save money were far more common among people who were prescribed drugs but didn’t have health insurance, nearly 40 percent of whom asked their doctors for less expensive treatments.
“These are pretty high proportions of people, and most concerning is [those] not taking their medication as prescribed,” said Stacie Dusetzina, a health policy researcher at Vanderbilt University who has studied drug affordability and wasn’t involved in the new report.
The report — which pulled from 2017 health survey data — found that the cost-cutting strategies generally declined from 2013 to 2015. But in the years since, the share of patients who report trying to find ways to save money on medicine has stayed steady. Dusetzina said that decline likely reflects the growing share of people who were covered by insurance during that time frame — and points to the importance of insurance coverage in being able to afford to take medicines as prescribed.
“It is very unaffordable for people to use most medications if they don’t have insurance,” Dusetzina said.
Just over 11 percent of adults prescribed medication in the past year said they didn’t take it as prescribed as a way to cut costs. The report defined that practice as skipping doses, taking less of a drug than prescribed, or waiting to fill a prescription.
Uninsured adults were far more likely to use that strategy to reduce their costs. More than 33 percent of people without insurance didn’t take their medication according to a doctor’s orders, compared to 8 percent of people with private insurance and 13 percent of people with Medicaid coverage.
Experts said that finding is particularly concerning. Not taking medications as prescribed has been tied to a slew of downstream effects, from increased rates of emergency room use and hospitalization to worsening symptoms of a health condition.
“We don’t want people cutting back on necessary treatments,” Dusetzina said. And taking drugs at too low a dose, or for less time than necessary, could also end up causing new problems, such as developing resistance to a drug, Dusetzina said.
“We have lots of treatments where if you don’t take them exactly as prescribed, you might be doing more harm than good,” she said.
The most common of the three cost-cutting strategies the report studied: asking a doctor to prescribe something less pricey. Roughly 20 percent of people who take prescriptions said they asked their doctor for a cheaper option in 2017, down from 26 percent in 2013. Women and those without health insurance were the most likely to ask doctors for a lower-cost drug.
Dusetzina said that while asking for a more affordable alternative highlights the challenges patients can face in paying for drugs, it could also be seen as a potentially positive cost-saving strategy for both patients and the health care system if the cheaper option works just as well.
Another 5 percent of adults who were prescribed medication said they used alternative therapies as a way to reduce their drug costs, with uninsured individuals most likely to opt for that strategy. Nearly 14 percent of uninsured people reported that they turned to different treatments as a way to reduce their costs, compared to 6 percent of people with Medicaid coverage and 4 percent of people with private health insurance.
Dusetzina said the potential risks — or benefits — of that practice depend on the type of substitution being made.
“You would really want to make sure that the alternative therapies are truly equal when it comes to clinical benefit,” she said.
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Although it’s obvious not taking a drug as prescribed is an issue for health reasons, there’s an implication here that a patient asking for a cheaper alternative is a problem, which is simply not true. Even with insurance, patients usually pay for prescriptions out of pocket until (usually large) deductibles are met. So patients are rightfully cost-conscious and smart to want to spend their money on things other than drugs whenever possible. Physicians are too often oblivious to the ways they unnecessarily contribute to the problem of drug/healthcare costs in this country. I’d like to see patients “train” doctors to be more conscientious about it by constantly asking, “Is there a less expensive way to accomplish the same thing?”
I had to practically argue with my physician to let me try the generic of a drug ($30/month) first before going to the much more expensive ($300/month) brand name. She always defaults to the brand version, saying many of her patients had side effects with generic. “Fine,” I said. “I’ll carefully watch for problematic side effects and promise I’ll switch if that happens.” Five years later, with zero issues with the generic, I’ve now saved myself thousands of dollars.
On a more basic but much more common level, I’ve lost track of the number of times I’ve heard doctors and nurses recommend — and prescribe! — “Tylenol” or “Advil” instead of saying acetaminophen or ibuprofen. The brand names are 2 to 5 times more expensive than the generic and by talking that way to patients instead of educating or encouraging them to use generics, physicians are complicit in the problem of drug mark-ups in this country.
Physicians consume far more medical care dollars than drugs, but we will never read a STAT article about the strategies sick people use to care for themselves in the face of the medical cartel’s rapacious pricing.
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