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PHARMACOECONOMICS

Physicians' Perceived Knowledge of and Responsibility for Managing Patients' Out-of-Pocket Costs for Prescription Drugs

Instructor, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Steven M Asch, MD MPH

Associate Chief for Research in General Internal Medicine, Veterans Affairs Greater Los Angeles Health Care System; Associate Professor of Medicine, David Geffen School of Medicine at University of California at Los Angeles (UCLA); Senior Natural Scientist, RAND Health, Division of General Internal Medicine, Los Angeles, CA

George J Joseph, MS

Research Associate, Center for the Study of Healthcare Provider Behavior, Veterans Affairs Greater Los Angeles Healthcare System; Doctoral Student, Department of Health Services, School of Public Health, UCLA

Henry N Young, PhD

Assistant Professor, Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin—Madison, Madison, WI

Susan L Ettner, PhD

Professor, Division of General Internal Medicine and Health Services Research, UCLA

Yelena Kholodenko, BA

Research Assistant, Department of General Internal Medicine, Veterans Affairs Greater Los Angeles Healthcare System

Peter Glassman, MBBS MSc

Staff Physician, Veterans Affairs Greater Los Angeles Healthcare System; Professor of Medicine, UCLA; Consultant in Health Policy, RAND, Santa Monica, CA; Staff Physician, Division of General Internal Medicine, Veterans Affairs Greater Los Angeles Healthcare System

Richard L Kravitz, MD MSPH

Professor, Department of Internal Medicine; Director, Center for Health Services Research in Primary Care, University of California Davis, Sacramento, CA

Reprints: Dr. Shrank, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St., Ste. 3030, Boston, MA 02120-1613, fax 617/232-8602, wshrank{at}partners.org

BACKGROUND: Most insurers in the US have implemented incentive-based formularies that rely on out-of-pocket costs to influence prescription drug utilization. Medicare Part D plans have broadly adopted such benefit designs.

OBJECTIVE: To evaluate physicians' perceptions of their knowledge of formularies and out-of-pocket costs, factors that influence knowledge of costs, physicians' perceived responsibility for helping patients manage their out-of-pocket costs for prescription drugs, and physicians' perceptions of the role of pharmacists in managing these costs.

METHODS: A multiple-choice survey was mailed to a random sample of 1200 physician members of the California Medical Association; a phone survey of nonresponders was then conducted.

RESULTS: Of 1027 surveys delivered to correct addresses, 509 (49.6%) responses were received. Thirty-three percent of physicians reported that they were usually or always aware of patients' formularies and 20% were usually or always aware of patients' out-of-pocket costs for medications. Surgeons, emergency department physicians, and physicians that prescribe from more formularies than other physicians are less likely to be aware of patients' out-of-pocket costs, while physicians in large practices and those who use computers to prescribe are more aware. While 91% of physicians agreed that it is important that patients' out-of-pocket costs be managed, 40% somewhat or strongly agreed that it is their responsibility to help. Sixty-five percent of physicians believed that it is the responsibility of the pharmacist to be familiar with patients' out-of-pocket costs.

CONCLUSIONS: Physicians often lack the knowledge to assist patients in the management of their out-of-pocket costs for prescription drugs and they depend on pharmacists to help patients manage those costs. Computer order entry and resources available in large physician organizations improve physicians' awareness of out-of-pocket costs when prescribing.

Key Words: out-of-pocket costs, pharmacy benefit design, prescription drugs

Published Online, August 15, 2006. www.theannals.com, DOI 10.1345/aph.1H158

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