When drug prices are too high, older patients don’t take their medicines. How can physicians help?

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Older patients are skipping their prescription medications due to high prices – and they want to talk to their physicians about those costs.

But you risk their wrath if pricing information is not accurate.

The findings were part of a new study, “Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022,” published in JAMA Network Open.

A 2022 survey of 2,005 adults aged 65 and older found 20.2% reported cost-related medication nonadherence. Some used “extreme forms of cost-coping,” with 8.5% skipping basic needs and 4.8% going into debt to afford their prescription drugs.

“Although prescription drug affordability is a challenge, there are important opportunities for clinical intervention to help patients avoid cost-related nonadherence,” the study said.

By the numbers

Popular forms of cost-related nonadherence include:

• Delaying prescription fills – 12.9%
• Not filling prescriptions – 11.1%
• Taking less medication or skipping doses – 7.9% each
• Using someone else’s medication – 1.9%

Many respondents reported more than one form of nonadherence, the study said.

How do patients cope with high prices?

• Copayment cards or coupons – 30.4%
• Asking a physician for lower-cost meds – 25.6%
• Shopping around for lower prices – 25.2%
• Asking physicians for free samples – 17.8%
• Buying prescriptions from other countries – 4.8%

Talking and tools

What can physicians do to help their patients?

• Start by screening. A full 89% of respondents said they were comfortable or neutral about being screened before a physician’s visit, for their interest in talking about prescription costs.
• Talk about it. “When asked if they would like to speak to their physician about the price of their medications, 40.3% of respondents said yes, 39.0% said it would depend on the medication, 10.5% said no, and 10.2% said they were unsure,” the study said.
• Use the tools. Overall, 89.5% of respondents said they wanted physicians to use real-time benefit tools, and 89.8% wanted to discuss the estimated prices with their doctors.

Do the tools work?

Real-time benefit tools have been required for Medicare Part D since 2021 and are meant to be specific to patients, pharmacies, and times.

But their accuracy is unclear. Implementing them “is challenged by potentially incomplete data,” especially due to interoperability – or lack of it – between prescription drug plan data from insurers and electronic health records, the study said.

Then, if a patient waits to fill a prescription or goes to a different pharmacy, the drug price may be different, the study said.

That can hurt the doctor-patient relationship – 41.5% of respondents said they would be “extremely upset” if there was a huge difference between real-time benefit tool estimates and the actual pharmacy prices. That price gap could also make patients less likely to fill their prescriptions, the study said.

Potential solutions

The researchers recommended three steps meet patient needs while acknowledging potentially inaccurate information.

• Health systems, developers of health information technology, and policy makers should make the real-time benefit tools available to all prescribers, with health system leaders investing in them.
• Physicians should use the tools in the context of cost conversations. Physicians may warn patients about potential price discrepancies and could opt to tell patients to have pharmacists contact the physicians if there are large discrepancies in drug prices. The researchers said more study is needed to maximize the tools and communication for patients, physicians, and pharmacists.
• Physicians could engage other health care team members, including pharmacists and nurses, to support medication cost discovery and cost conversations. “This proactive approach also reduces the burden on patients and caregivers, reduces trips to the pharmacy, and could ultimately prevent cost-related nonadherence,” the study said.