Tips to Help Your Patients Manage Their Drug Costs

The high cost of many medicines in the United States may make it easier for clinicians to start necessary conversations about whether patients will be able to afford to fill the prescriptions written for them.

In the past, it was a more sensitive topic as patients could be reluctant to discuss their finances, said Kevin Fiscella, MD, MPH, professor of family medicine and public health sciences at the University of Rochester Medical Center, Rochester, New York.

But patients increasingly are confronting both rising drug prices and skimpier medical benefits. Clinicians are likely to hear more from patients right now, as deductibles and copays reset for the year.

“They may be bearing the full cost of the medication until they hit the deductible,” Fiscella said. “And oftentimes you can have very high copays, depending on the formularies.”

A December federal report noted that many employer-sponsored health insurance plans are shifting from fixed copayments to requiring workers to pay a percentage of drug costs. Health plans also continue to use cost-sharing tiers for medicines, forcing patients to pay more for more expensive brand name drugs.

Patients often face “sticker shock” at the pharmacy, Fiscella told Medscape Medical News.

Too often clinicians learn too late that a patient has not been able to take medicines as prescribed or even purchase them, Fiscella said. That’s why physicians should discuss the cost of needed medicines during the visit.

“We could spend a lot of time picking the right medication, but if the person can’t afford it, we’re basically wasting time,” Fiscella said. “It is worth checking with the person. We want to be sure that we’re doing the right thing.”

Polling data from the nonprofit KFF found that about three in ten adults who participated in a 2023 survey reported not taking their medicines as prescribed at some point in the past year because of the cost.

For people enrolled in Medicare Part D plans, two changes take effect this year that can help with pharmacy bills.

A provision of the Inflation Reduction Act of 2022 establishes a $2000 limit on out-of-pocket spending for drugs purchased through Part D. The law also will allow Medicare recipients to spread out costs of expensive medicines, although this does not change the amount paid.

Medicare also is negotiating discounts on some drugs, with the first set slated to begin in 2026.

The new Medicare Part D protections apply to about 56 million people enrolled in these drug plans and not to general commercial plans that serve about 200 million US patients.

Fiscella is among physicians who are researching how clinicians can best help patients afford the medications prescribed for them. Here are three tips drawn from their research.

Tips For Talking to Patients About Drug Costs

1. Ask the right question — in the right way.

Small steps may make a difference in sparking important conversations with patients about their struggles to afford medicines. In 2019, Fiscella and coauthors published a paper in the Annals of Internal Medicine about a study on the effects of training clinicians and staff about how to raise and address concerns about cost of medications.

With seven practices participating in the study, Fiscella and colleagues found that even a single 60-minute training session appeared to make a difference. These training sessions involved a 20-30–minute slide presentation, followed by group discussion.

In the initial surveys, 17% of patients reported having had a discussion about costs of medications, a figure that rose to 32% after the training sessions were held.

In a 2019 article for the American Academy of Family Physicians journal, FPM, formerly Family Practice Management, Fiscella and coauthors offered many practical suggestions about working questions about patients’ ability to afford medicine into the already busy schedules of the staff of a medical practice.

For example, practices can post a simple sign: “Having trouble affording your medications? Tell your doctor or nurse today!”

Clinicians and staff of medical practices should aim at using straightforward wording. It’s important to normalize conversations about challenges of affording medicines, they wrote. Some patients may be more apt to share information about their struggles to obtain medicine with nursing or other office staff than with their physicians.

2. De-prescribe where needed. Do a ‘brown bag visit’ with patients.

One of the best ways to save patients money on medicines is make sure they are taking the right ones, Fiscella said. It’s not uncommon for older patients with multiple health conditions to take numerous drugs, sometimes as many as 20.

“Sometimes these medications are of low benefit, or even worse, that had been started for various reasons,” Fiscella said. “That can also save the person some money by stopping medications that are really no longer needed.”

Clinicians can ask patients to bring in all of their medications for a review, a practice often known as a “brown bag visit.” The idea is for the patient to gather and bring into the office all of the drugs they take for the physician to review.

Otherwise, it can be difficult for a patient to try to explain to a physician what medicines they are taking. Patients may identify medicines by their color, talking about red pills and green pills, he said.

“Most of us have no idea what color looks like because if we’re prescribing generics, they could be any color,” Fiscella said. “So, if they bring in their bag, you can see what they’re on.”

3. Be prepared to direct patients to programs that can help them.

The 2019 articleFPM article by Fiscella and colleagues includes a chart reviewing patient assistance programs.

Last year, JAMA also published a review of strategies for helping patients afford their medicines, along with a patient page on this topic.

In an email exchange with Medscape Medical News, the lead author of the JAMA review, Hussain Lalani, MD, MPH, MSc, of Brigham and Women’s Hospital in Boston urged his fellow primary care physicians to try dedicating time to make sure their patients get the help they in obtaining medicines. He also recommended including clinical team members, including medical assistants, care navigators, and office staff in these efforts.

“You can empower patients and families by printing the JAMA Patient Page and sharing it with anyone struggling to afford their medicines,” Lalani said. “This is a great educational resource and will help them to get started.”

Fiscella and coauthors received support from the Robert Wood Johnson Foundation for the research reported in the Annals of Medicine.

Lalani and coauthors had support from Arnold Ventures for the study reported in JAMA.

Kerry Dooley Young is a freelance journalist based in Washington, DC. Follow her onLinkedIn, Bluesky, andThreads.