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Few providers discuss glaucoma drug costs with patients
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Providers should address glaucoma medication costs to prompt a discussion of potential cost-related barriers to treatment, according to researchers who evaluated patient visit recordings with ophthalmologists.
“The few discussions of cost at the baseline ophthalmic visits leave room for improvement for providers to discuss early on in order to improve adherence from the beginning of glaucoma treatment,” the researchers wrote.
The 275 participants were gathered from a larger observational study of glaucoma communication and patient outcomes of adult glaucoma patients and 15 ophthalmologists from six ophthalmology clinics located in four states. Eighty-seven of the 275 successfully videotaped office visits included a medication cost discussion, according to researchers.
The majority of subjects (60.7%) had mild disease severity, 57.5% were women, and the average age was 66.2 years. Most subjects (57.5%) had Medicare coverage, and the majority (89.7%) had some form of prescription insurance.
Patients divulged that cost was an issue in 13 (4.7%) of the 275 participant visits examined.
Among patients with no medical insurance, two (28.6%) indicated cost was a problem, whereas only 11 (4.1%) of the patients with medical insurance indicated cost was a problem.
Researchers found that physicians asked about medication cost potentially being a problem in four of the videotaped glaucoma office visits. Physicians proposed a solution to the potential cost problem in 17.9% of the total visits.
Physicians asked the patient what they were paying for their medications in 2.2% of the videotaped glaucoma visits. Patients discussed changing their medication regimen because of a cost problem in 6.1% of the total visits. Health insurance or prescription drug coverage was discussed in 14.7% of the recordings.
It was more likely for patients to discuss health insurance or prescription drug insurance if they were starting glaucoma medications for the first time.
Patients may experience cost barriers, but often do not raise the issue with their physicians, according to researchers.
“In order to improve these discussions, health care providers should consider initiating a brief discussion of medication cost,” researcher Catherine Slota Gupta, PhD, said in interview with Primary Care Optometry News. “This is crucial in determining if medication cost is a barrier to adherence, which could impact health outcomes associated with glaucoma.”
Discussions of cost should be tied to addressing the long-term nature of treatment required for glaucoma, she said.
“Reminding patients that they will likely have to take this medication daily for the rest of their lives may help to get them engaged in discussing cost,” she added.
Medical schools and continuing medical education courses should include lessons on how to recognize and assist with medication cost issues, the researchers concluded. – by Abigail Sutton
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Glaucoma is a largely chronic, slow progressing, asymptomatic eye disease. Lowering IOP slows the progression and, on whole, topical medications are arguably the best treatment. Adherence, side effects, convenience and cost are impediments to successful treatment.
Slota and colleagues focus on the cost aspect and teach us what we already know but may not want to admit: We aren’t very good at discussing medication costs with our patients. This is bound to have a negative effect on treatment.
When did you last have to authorize a change to another prostaglandin analogue due to changing insurance coverage? Are you getting tired of handing out coupons and filling out prior authorizations? Are you frustrated that new, exciting medications are not covered by insurance plans and are priced astronomically high? Honestly, we could use a simpler, more equitable, system that works for most.
Until this happens, take a deep breath, fill out paperwork, hand out coupons and please have a frank discussion about medication cost with your patients. It may not seem to be what you signed up for, but it’s what you signed up for.
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