Some see it as an eternal struggle: the goodhearted doctor championing the best treatments, no matter the cost, while doing battle against the tightfisted insurance company denying claims for expensive but life-saving medications.
But when you get down to it, their goals often dovetail: the best care for patients at affordable prices.
After all, even if a plan sponsor or insurer picks up part of the tab, the cost of pricey medications may convince them to increase their deductibles or copayments, which will have an impact on future patients.
But at a time of increased concern about the sustainability of benefit plans, what’s the role of the doctor in helping to contain drug costs?
“I do think that physicians have a duty not just to the patient in front of them but to society at large,” says Dr. Peter Ubel, a professor of business, public policy and medicine at Duke University in Durham,
N.C. Just as he uses the strongest antibiotics only for the worst bacterial infections in order to protect public health, he’ll save expensive tests and medicines for occasions when cheaper alternatives aren’t successful. “I go right to an MRI rather than an X-ray, I’m burning through societal resources and that causes harm,” he says of the drawbacks of not keeping costs in mind.
Doctors should also consider the cost of drugs because unaffordable prescriptions lead to greater rates of non-adherence and, therefore, worse health outcomes. A 2016 study from Statistics Canada found that western Canadians with cardiovascular-related conditions who spend at least five per cent of their household income on drugs were three times as likely not to get the necessary medication as those who spend less than that amount.
“If patients can’t afford the medications, they don’t take them and then they don’t benefit from them,” says Dr. Yousuf Zafar, an oncologist and an associate professor of medicine at Duke University.
And that means they’re more likely to call in sick or, if they do make it to the office, work less productively.
While doctors wouldn’t prescribe a drug without making sure the patient understands the possible physical side-effects, they often don’t discuss the financial impacts with them. “To know what the best pill is for somebody, you need to know what they care about,” says Ubel. “And if they care about their out-of-pocket expenses, that might change what you prescribe.” But few doctors know how much their prescriptions cost, he notes.
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