A prescription is worthless if a patient can't afford it

Make sure patients can afford meds, or get assistance

Knowing that you have hit on the ideal medication for your patient's condition is a satisfying feeling. But if you fail to ask one important question before handing him the prescription — "Can you afford this medicine?" — your careful thought may have been wasted.

"A physician has an obligation to get patients the medication they need; but they [also] need to be aware if the patient can't afford the medications the physician is prescribing," says Richard J. Sagall, MD.

Sagall is a family practice and occupational medicine physician and consultant in Philadelphia who has spent several years building a Web-based, nonprofit resource, NeedyMeds.com, to help match patients with assistance in getting medications and care they might not be able to afford.

Inquiring about a patient's ability to afford prescribed medications is a question many doctors fail to ask, Sagall says.

"Doctors who don't deal with this issue by asking if the patient can afford to buy the medicine are wasting their patients' time and their own," he asserts.

Some doctors might not think of asking; others might just forget. It might be an obvious question to ask a patient you know is uninsured, Sagall says, but sometimes it's easy to assume that a patient with insurance can afford the copay his or her plan requires, when the truth is that the patient cannot afford even a $10 or $20 charge.

Patients' conditions go untreated

While some drug plans provide generic or inexpensive prescription drugs at no cost or for a nominal feel, some "upper tier" or newer drugs can result in a hefty copay not affordable for some low- or fixed-income patients.

A Department of Veterans Affairs study published in 2004 showed that two-thirds of the 660 chronically ill older adults studied never told their doctors ahead of time that they planned to underuse their medications due to cost concerns, and 35% never told their doctors at all.

"If we don't ask, our patients usually won't tell," Sagall points out. "This is such an important thing, and a lot of physicians don't consider it. Not because they don't care, but because there is so much else to consider [during a patient encounter] that it is not high on their list of priorities."

According to a study funded by the National Institute on Aging, part of the National Institutes of Health, middle age and older Americans with heart disease who cut back on their prescribed medications because of cost were 50% more likely to suffer heart attacks, strokes or angina than those who did not report cost-related medication underuse. The authors, physicians with the Veterans Affairs Ann Arbor Heathcare System, also found that older patients who restricted medications due to cost concerns had increased rates of depression.

Sagall suggests physicians look at all available options before prescribing medications their patients have trouble affording. Among other alternatives:

  • Non-medicinal treatments, such as weight loss, smoking cessation, and exercise can help, but only so much, Sagall concedes.
  • Generics can cost up to 90% less than the brand-name drugs, but are not available for every condition.
  • Old standbys — older drugs, rather than the latest drugs on the market — may be more affordable. However, they may not always be the best choice for certain patients.

Sagall also advises physicians to familiarize themselves with how much the drugs they prescribe cost.

"And while you might have a favorite drug that you really like, in terms of its effects, you have to consider whether the difference in benefits justifies what might be a higher price," he adds.

PAPs, other assistance available

There are resources available to patients who need help purchasing needed medications, but most may not be aware of the programs, and if they are, they need a physician's help in qualifying.

Patient assistance programs, or PAPs, are programs offered by pharmaceutical companies to low-income individuals and families. They typically require a doctor's consent and proof of income and insurance (or lack thereof).

Sagall developed NeedyMeds.com almost 10 years ago along with a home health social worker who had created a database of assistance programs for clients who could not afford their medications. Sagall said the list became a Web site, which has grown exponentially.

"For almost every condition, there are medications available through patient assistance programs," says Sagall. NeedyMeds.com identifies more than 350 companies or programs, as well as 200 state-funded programs, offering nearly 2,700 drugs and dosages.

The Pharmaceutical Research and Manufacturers of America, an association of pharmaceutical companies, reports that its member companies distributed free of charge more than $4 billion worth of medications through PAPs in 2004.

NeedyMeds.com has expanded to provide information not only on PAPs, but also on disease- or condition-specific resources (e.g., cancer, Parkinson's disease, amputations), paperwork and application assistance services, and government-sponsored assistance programs.

"We have designed it so that with four clicks of the computer [mouse], you should be able to find what you are looking for," he says. Despite its ease of use, Sagall points out, patients may need their physicians' help in first finding the program, and then taking advantage of PAPs or other programs that can assist them. NeedyMeds also offers brochures that physicians can order for their offices or download and print out for patients.

"Our philosophy is that if we can teach people how to get help, they can continue to get it on their own," he says.


For more information

  • Richard J. Sagall, MD, president, NeedyMeds.com, P.O. Box 63716, Philadelphia, PA 19147. E-mail rich@needymeds.com
  • Piette JD, Heisler M, Wagner TH. Cost-related medication underuse: Do patients with chronic illnesses tell their doctors? Arch Intern Med 2004; 164:1,749-1,755.
  • Heisler M, Langa KM, Eby EL, et al. The health effects of restricting prescription medication use because of cost. Med Care 2004; 42:626-634.