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The rising cost of medicines may be a growing problem for many Americans, but a new survey finds that cost is generally not a key factor when doctors decide which treatments to prescribe their patients.

Among six different types of doctors queried, only primary care physicians cited cost as among their most important considerations. Forty-seven percent ranked the issue as a key concern, behind evidence that a drug is safe, effective and well-tolerated.

The various specialists – oncologists, cardiologists, neurologists, dermatologists and pulmonologists – also named these attributes as the most important issues to consider. But cost was much less of a consideration compared with 10 other concerns that were cited, according to the survey CMI/Compas, a market research firm that queried more than 800 doctors last June.


For instance, just 25 percent of cardiologists pointed to cost as the most important factor. Cost ranked as the fifth most pressing concern among dermatologists, as 40 percent called it a factor. Thirty-three percent of oncologists cited cost, making it only the sixth most important issue. Neurologists named cost as the eighth most pressing matter. And pulmonologists ranked cost as least important.

Why is there such a difference between the primary care doc and the specialists?


“This is likely because of the nature of the visit with the primary care doctor and what that may entail,” explained a spokeswoman for the research firm. “Imagine you’re a primary care physician who needs to keep track of a huge range of potential diagnoses and cures. You have a patient complaining of persistent GI issues. Could it be a food allergy, constipation, Crohn’s disease?  It’s likely you’d want to start by prescribing a lower-cost medication addressing the most likely culprit.”

“There may also be pushback from the patient who may feel concerned about cost, more so than a patient with a chronic or life-threatening illness,” she added.

Of course, this is reflects a certain amount of speculation. Nonetheless, the findings suggest that many physicians remain more concerned with finding the best medicine for the ailment at hand, as they should. But this will also place more of the onus on patients to talk to their doctors about affordability when reviewing treatment options.

The survey, by the way, also looked at other issues confronting physicians. Here are some of the results: 89 percent of primary care docs are likely to prescribe a specific drug when requested by a patient, compared with 62 percent of oncologists. The other specialists fall in between this range. However, primary care docs report patients ask for a specific drug just 56 percent of the time – and that drops to 33 percent, according to the pulmonologists and oncologists surveyed.

As for those keeping up on research literature, attending conferences, following medical news and staying abreast of clinical trials, the responses ranged from 39 percent of neurologists and dermatologists to 56 percent of cardiologists. And most rely on medical meetings and professional journals, but relatively few cited product web sites.

And many docs will try a new drug or device they have not used before after obtaining clinical information from a company, ranging from 55 percent of oncologists to 71 percent of dermatologists. However, most will also conduct further research using other sources, ranging from 66 percent of dermatologists to 74 percent of cardiologists and oncologists.

Last, but not least, attitudes toward sales reps remain mixed. Among primary care reps, 10 percent say interactions violate policy, down from 18 percent in 2015. Similarly, fewer cardiologists and neurologists cited policy concerns. But among pulmonologists and oncologists, 21 percent reported that meeting with sales reps violates policy, up from 13 percent in 2015.

  • Perfect example of how health care costs continue to rise. The current generation of prescribers have no incentive, knowledge, or responsibility of how prescription drug prices directly influences cost.

    Until they’re taught otherwise, or policy change incorporates it into reimbursement, this trend will continue.

  • Certain specialists are not only aware of the high cost of drugs but help the patients get on a Patient Assistance Program. For example, my dermatologist highly recommended highly a drug called Cosentyx for my psoriasis, but I told him I didn’t exactly have $45,000 burning a hole in my pocket so we went after another new but less expensive product that carried with it a copay assistance program.

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