Americans cutting back on health spending by skipping prescriptions, procedures

By Dr. Ananya Mandal, MDSep 28 2011

A Consumer Reports survey revealed that more Americans are ignoring their doctor’s advice and skipping prescription drugs or medical procedures to save money in 2011 than a year earlier.

Almost half of the 1,226 consumers taking at least one medication said they didn’t fill prescriptions, took less medicine than a prescribed dose or failed to undergo a medical test advised by their physician, according to the survey. That’s 9 percentage points higher than the 39 percent reported in 2010 by the annual survey. Of the 2,038 nationally representative adults contacted this year, 49 percent (1,226) said they currently take at least one prescription medicine.

The national telephone survey of those older than age 18 was conducted June 2 through June 6 and has a margin of error of plus or minus 2.9 percentage points. The survey began in 2008.

One in six American households and one in four with incomes less than $50,000 told New York-based Consumer Reports that they felt stress over how much they must spend on medical care. The pressure is prompting consumers to pursue potentially dangerous strategies for coping, said John Santa, director of Consumer Reports’ Health Ratings Center. “The rising percentage of people putting off health care makes us wonder if we are really done with the recession,” Santa, a physician, said. “This is one of the most sensitive barometers of how people are coping with the financial pressures.”

Doctors need to ask patients whether they are having trouble paying for drugs or medical care, and patients - if doctors fail to ask - should tell them when they are financially stressed, Santa said. Only 5 percent of the survey said they found out about the cost of a drug at the doctor’s office; 64 percent were told by their pharmacists. “In some cases, doctors don’t have these conversations with their patients because they just don’t know how much a drug or procedure costs,” Santa said.

Patients said their choice of medication was influenced by advertising. Eighteen percent of those surveyed said they asked their doctor to prescribe a drug they saw advertised and 70 percent of those who asked said their doctors wrote the prescription.

The survey found the use of generic drugs increased to 75 percent of the prescriptions filled compared with 73 percent in 2010. Even so, 39 percent of respondents didn’t know that generics must meet the same federal standards on safety and efficacy and contain the same active ingredient as their brand- name counterpart. Forty-one percent said their doctors only sometimes or never recommended a generic.

In fact, generic drugs are made with the exact same active ingredient as their brand-name equivalents and are regulated in the same manner. And manufacturers must prove that the active ingredient enters and leaves the bloodstream as fast or as slowly as brand-name versions, which means the therapeutic effect should be the same.

“If patients are given a choice they are more likely to fill the prescriptions for pain relievers or drugs that treat specific symptoms they are experiencing,” Santa said. “Unfortunately, they don’t always fill the prescriptions for drugs that treat conditions like diabetes or high blood pressure which may not be causing them trouble now but will if they don’t take the medication.”

Consumer Reports is published by Consumers Union, a nonprofit research and advocacy organization.

Overall the results showed that 21% put off a doctor’s visit, 17% delayed a medical procedure and 14% declined a medical test. 28% took significant risks with their medication to save money. At least 16% did not fill their prescriptions, 13% took medications beyond their expiry dates, 12% skipped a dose without asking a doctor or pharmacist, 8% split pills in half without consent of their doctor or pharmacist and 4% shared their prescription with someone else.

Experts advise that patients need to talk to their doctors about cost when he or she prescribes a medication, especially one that needs to be taken long-term for a chronic condition. One must ask if a generic version is available. Pharmacists may also help with cost issues. Many chain pharmacies offer a month’s supply for about $4 or three months for $10, though restrictions do apply. Also free samples should be avoided as much as possible. They’re usually for the most expensive medications that don’t have generic equivalents, and that can be costlier when it’s time to fill the prescription.