US doctors rarely discuss with their patients the costs of medications when prescribing them for the first time, yet cost is a major reason for patients not taking their medicines correctly, says new research.

“The enormous potential of medicine to cure and treat medical conditions is often unrealized when medications are not obtained or are not taken as directed because of cost or acquisition problems,” says the report, which appears in the November issue of the American Journal of Managed Care.

The researchers, who examined 185 outpatient encounters with 15 family physicians, 18 internists and 11 cardiologists in the Sacramento area, found that the doctors initiated discussions on cost and insurance issues relating to newly-prescribed medicines in only 28 cases.

Moreover, actual prices were mentioned in just 12 visits, with doctors asking their patients questions such as: “Is your insurance pretty good about covering your pills, or do you buy them out of pocket?” and “How much do you spend on your medications?” One doctor told a patient to let him know if his insurance plan did not cover the newly-prescribed medication so that he could change if for a product that was covered. Pill-splitting was also suggested, for example where an insurance plan only covered the 100mg version of a medicine but the doctor had prescribed the 50mg version for a patient.

Also, patients themselves brought up the issue of cost or prescription coverage for less than2% of newly-prescribed medications, but such discussions were more likely to occur when patients were earning less than $20,000 a year than when they were earning more than $60,000. Such discussions were also less likely to occur with older patients, the study found.

“Physicians must have a high level of awareness about medication cost and issues impeding acquisition to medication, because these can be important barriers to patient medication adherence,” concluded lead researcher Dr Derjung Tarn of the University of California, Los Angeles, David Geffen School of Medicine.