Medication Cost | September 2021 | Clinical Corner

September 1, 2021

"Are your patients struggling with the cost of medications?”

 No medication can be the best treatment for a patient if it costs so much that the patient cannot fill the prescription. CAHPS (Consumer Assessment of Healthcare Providers and Systems) is a program of some 26 years designed to understand the patient experience with healthcare. CAHPS surveys asks patients to report on their experiences with a range of health care services and experiences with providers (practice sites and health care providers). This information is then used to improve medical care delivery, patient outcomes and helps to address the spend on medications.


A random number of our Accountable Care Organization (ACO) patients receive the CAHPS survey for Accountable Care Organizations Participating in Medicare Initiatives.

Under the category of “All Your Care in the Last 6 Months”, Questions 29, 30 and 31 of this survey ask the patient if the subject of medications and the cost of those medicines was ever discussed.

  • Question 29, In the last 6 months, did you take any prescription medicine?
  • Question 30, In the last 6 months, how often did you and anyone on your health care team talk about all the prescription medicines you were taking?
  • Question 31, In the last 6 months, did you and anyone on your health care team talk about how much your prescription medicines cost?

Why are these questions important? “More than 40% of Americans are struggling to pay for the cost of their medicines – even though nearly all of them have some kind of health insurance coverage.” (1) “In addition to difficulty affording prescriptions, about three in ten (29%) of all adults report not taking their medicines as prescribed at some point in the past year because of the cost.” (2) While at the same time, “brand-named prescription drugs widely used by seniors saw a 2.9% price increase in 2020, twice the U.S. general inflation rate.” (3) According to U.S. Pharmacist, medication adherence can have a more direct impact on patient outcomes than the specific treatment itself; it is estimated that adherence to chronic medications is about 50%. (4) In 2020, the Staff News Writer of the AMA authored an article about the 8 reasons patients don’t take their medications – the first three were fear, cost and misunderstanding. (5)

These questions and the answers are important in medication reconciliation, medication adherence and the patient’s medical program. Visits (face to face, virtual, annual wellness visits, physical exams) offer an opportunity to discuss their medication profile, assess if they are taking the medications appropriately and determine barriers that must be addressed like cost and adherence.

Most of the time, patients will pay less for medications if they use their insurance plan. Only drug claims processed through the patient’s drug benefit are counted – not scripts utilizing GoodRx or store pharmacy discount programs or cash or samples. Payers like their members to utilize insurance so they can track cost and utilization. However, there may be times when a discount drug card program makes sense.

There are many strategies to consider that effect cost and adherence, listed below are a few:

  • Routinely, ask the patient if medication cost is an issue or barrier
  • Consider medication nonadherence first as a reason a patient’s condition is not under control
  • Utilize generic options
  • 90-day supply with refills
  • Refill synchronization
  • Mail order pharmacy services may be an option
  • Higher dosage of medication may enable cut to suit
  • Check and see if pharmaceutical companies have an assistance program
  • Utilize website apps to ascertain the best price locally – like GoodRx
  • Search for member prescription programs

Attention to medication cost, medication adherence and medication reconciliation will improve patient care, improve patient satisfaction, and reduce provider frustration.


(1). Thomas Goetz, MPH, MA, 11/25/2018, Health Insurance Aside, Americans Still Struggle to Pay for Their Medications.

(2). Kaiser Family Foundation – KFF Health Tracking Poll, 2/2019.

(3).  Taylor Avery, USA Today, 6/8/2021.

(4). Jennifer Kim, PharmD, BCPS, BCACP, CPP, 1/19/2018, Medication Adherence: The Elephant in the Room.

(5). Staff News Writer, AMA, 12/2/2020, 8 reasons patients don’t take their medications.