Failing to talk about cost not only hurts our wallet, it damages our health

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By Consumers Union on Tuesday, March 17th, 2009

We talk to our doctors about the most personal – and embarrassing – things. And doctors have never been shy about probing (literally) into some of the most intimate areas of our lives. Yet when it comes to talking about the costs of medical treatments, both patients and doctors fail miserably. And by avoiding the topic of cost, we often end up damaging our health, as well as our wallets.

A new Consumer Reports poll released today in conjunction with our “Best Drugs for Less” magazine finds that only 4 percent of those surveyed had a conversation with their doctor about the cost of a drug. That means only four out of every 100 of us ever had the guts to ask our doctor how much that latest drug being prescribed costs. And the odds are probably just as tiny that the doctor knows the answer.

“As a doctor, there is a no more disappointing feeling than getting a call from a patient at the pharmacy that they can’t afford the medicine you just prescribed for them. You just feel foolish,” Dr. John Santa, director of Consumer Reports Health Ratings Center, said today in releasing the poll results and new magazine in Washington, D.C. “The statistics show there is a real need for this information at the point of care.”

We’ve all likely been victim to that medical ‘sticker shock’ that the doctor refers to. The CR poll found that 66 percent of Americans have no clue about what their prescriptions cost until they’re picking them up at the pharmacy counter. And then panic sets in: Buy the medicine, or go without.

The poll found that more than a quarter of us (28 percent) have taken such dangerous actions to save money on prescriptions such as skipping doses, cutting pills in half without doctor guidance, or worse, not filling the prescription at all. People get sicker when they don’t take their medications, and then we all end up paying more in higher costs to treat them at the emergency room or critical care.

Consumer Reports began its free, public information Best Buy Drugs project nearly five years ago to help patients and their doctors begin having that sometimes embarrassing – but critically important – conversation about finding the most effective, affordable drug choices, so people don’t avoid treatment simply because it costs too much. CR uses unbiased, scientific evidence to compare medications to determine the most effective treatments, and then overlays price information so you and your doctor know what things cost.

Our research shows that generics often tend to be as effective as expensive, highly advertised brands for many diseases that take a financial toll on our nation — high-cholesterol, high blood pressure, heart disease and diabetes. Many of these generics are available for $4 a month at the brand-name chain stores. Billions could be saved each year if patients and their doctors discussed these choices and switched to lower-cost alternatives.

For far too long, patients and their doctors have been at the mercy of the giant drug companies, who bombard them with ads, marketing and free drug samples pushing the latest, most-expensive medications, which often are no more effective than generics costing much less. The CR poll found that one-fifth of people who regularly take a prescription have requested a drug they saw in an ad from their doctor. Meanwhile, we watch as our drug costs spiral into the stratosphere.

Congress recently approved $1.1 billion in the stimulus package to fund more comparative research, so we can know just how well medications stack up against each other, as well as other treatments and surgeries (important note: the government-funded research only compares effectiveness, not cost. Pricing information is what groups like ours can do, to help doctors and their patients find more affordable alternatives). This type of unbiased, scientific information helps level the playing field for consumers in a medical game where all the cards have been held by the drug companies.

But as the Washington Post reports, some are waging a not-so-subtle campaign against this type of research, claiming that if we know what medications works best, we’ll end up with our care rationed. But Dr. Santa argues that it’s actually the drug industry that’s doing the rationing of care – by marketing high-priced medications to consumers and doctors, and providing gifts to doctors to reinforce those prescribing decisions. Drug companies even pay other drug companies not to produce generics when patents run out so that lower cost alternatives are simply not available.

“The dominance of the drug industry in doctors’ prescribing decisions is creating rationing by the industry. Their ads, marketing and detailing to doctors all result in rationing care – to their latest, expensive products,” Santa said, which as we know, results in many patients not filling their prescriptions, and ultimately not getting care. “We think its time to have a balance between the consumer and drug industry, and comparative effectiveness research will help give us fair and balanced information.”

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