Is your patient sick—or hungry?

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Applied Evidence

Is your patient sick—or hungry?

J Fam Pract. 2012 May;61(5):248-253

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References

1. Tavernise S, Gebeloff R. New way to tally poor recasts view of poverty. New York Times. November 7, 2011. Available at: http://www.nytimes.com/2011/11/08/us/poverty-gets-new-measure-at-census-bureau.html?_r=2&scp=1&sq=poverty&st=cse. Accessed March 12, 2012.

2. Income poverty and health insurance coverage in the United States: 2010 [press release]. Washington, DC: US Census Bureau; September 13, 2011. Available at: http://www.census.gov/newsroom/releases/archives/income_wealth/cb11-157.html. Accessed March 12, 2012.

3. Short K. The research supplemental poverty measure: 2010. Washington, DC: US Census Bureau; November 2011. Available at: http://www.census.gov/hhes/povmeas/methodology/supplemental/research/Short_ResearchSPM2010.pdf. Accessed March 13, 2012.

4. University Mailman School of Public Health. Death by poverty? June 16, 2011. Available at: http://www.mailman.columbia.edu/academic-departments/epidemiology/research-service/death-poverty. Accessed March 5, 2012.

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6. Muennig P, Fiscella K, Tancredi D, et al. The relative health burden of selected social and behavioral risk factors in the United States: implications for policy. Am J Public Health. 2010;100:1758-1764.

7. Columbia University Mailman School of Public Health. Poor face greater health burden than smokers or the obese. Available at: http://www.mailman.columbia.edu/academic-departments/health-policy/news-events/poor-face-greater-health-burden-smokers-or-obese. Accessed March 13, 2012.

8. Schwartz K. How trends in the health care system affect low-income adults: identifying access problems and financial burdens. December 21, 2007. Kaiser Family Foundation. Available at: http://www.kff.org/uninsured/7705.cfm. Accessed March 2, 2012.

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10. Consumer Reports poll: 48 percent of Americans on meds making risky health care tradeoffs [press release]. Yonkers, NY: Consumer Reports; September 27, 2011. Available at: http://www.prnewswire.com/news-releases/consumer-reports-poll—48-percent-of-americans-on-meds-making-risky-health-care-tradeoffs-130618778.html. Accessed January 3, 2012.

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Keep drug costs down
Physicians can help to insulate their poor and low-income patients from high drug costs in a number of ways:

Reduce polypharmacy. Half of Americans take at least one prescription drug, according to the 2011 Consumer Reports survey. Among this group, people with limited income—those earning less than $40,000—take, on average, 5.7 different drugs.¹⁰ Eliminating unnecessary medications, including supplements, herbs, and any other over-the-counter products, can lead to substantial savings. To determine what can be eliminated, ask patients to bring in everything they’re taking and conduct a brown bag medication review. To learn more, see “Help your patient ‘get’ what you just said: A health literacy guide” (J Fam Pract. 2012;61:190-196).

Prescribe generics. Newer brand-name drugs may not be markedly better than older, established agents. And many generics are available at major retailers like Wal-Mart for just a few dollars for a 30-day supply or at CVS for $9.99 for a 3-month supply.²⁶ Yet some physicians routinely order newer medications, even for indigent patients.

Be upfront about drug costs. When you prescribe a new drug, whether generic or branded, it is important to discuss the cost (easily accessible online and in many electronic medical record systems) with the patient. Yet only 5% of respondents to the 2011 Consumer Reports survey said their health care providers had done so. Two-thirds of those surveyed (64%) did not discover the cost of a drug until they went to a pharmacy to pick it up.¹⁰

Think twice before handing out samples. Drug samples would appear to benefit the poor and the uninsured, but evidence suggests otherwise.^27,28 In a study that assessed out-of-pocket costs associated with the use of samples, patients who had never received samples had lower out-of-pocket costs.28 That’s partly because most samples are newer, more expensive drugs, and patients who start taking them are often unable to afford the cost of a prescription. Another study found that the use of generic drugs for uninsured patients rose (from 12% to 30%) after the clinic discontinued the use of samples.²⁷

CORRESPONDENCE Laura C. Lippman, MD, 2311 North 45th Street, No. 171, Seattle, WA 98103; lclippman@gmail.com