5 ways to talk about affordability with patients before they get to the pharmacy

Colin Banas: ©DrFirst

The cost of prescriptions often forces patients to make difficult choices. Our research shows that one out of five Americans say they stop taking their medications or take fewer doses than prescribed when finances are tight, making discussions about finances a critical part of patient care.

It’s heartbreaking when a patient returns to your office or arrives at the emergency department in worse shape than when you last saw them. When that happens, it’s often because the patient doesn’t have the financial means to fill crucial prescriptions.

It is far easier—and impactful—to have open and transparent discussions with patients in the moment of care when you can discuss options and access additional resources in the clinic setting. Trying to handle these issues hours or days later, in the dead of night, or worse, not at all, can lead to adverse events.

Here are five actionable tips for navigating these sensitive conversations:

1. Initiate the money conversation early

Bring up affordability as early as possible. Being upfront about costs fosters trust and reduces the likelihood that patients will avoid treatment altogether.

There’s a direct link between a patient’s financial ability and adherence to treatment plans. By regularly asking about affordability, you’re not only addressing immediate barriers but also ensuring long-term treatment success.

Conversation prompt: "This is the treatment I think is best in your situation, but I realize it might not be affordable. I do have some other options we could consider if you’d like to go over them.”

2. Ask everyone—no assumptions

Economic vulnerability isn’t always visible. Patients who seemed financially stable last year may be struggling this year. In a volatile economy, no one is immune to sudden financial changes. Get in the habit of asking all patients about their ability to afford care and never assume they’ll speak up on their own.

Conversation prompt: "I ask every patient in my practice whether treatment affordability may impact the decision to start/continue treatment. Is there anything I can do to help you with any hesitations you have about the cost or impact of the therapy?”

3. Offer to review benefit coverage

Understanding the nuances of insurance plans can be overwhelming, even for the most informed patients. Don’t assume they understand coverage details, co-pays, co-insurance, prior authorizations, or the difference between medical and RX benefits. Sometimes, simply clarifying what’s covered can make all the difference in a patient’s decision to proceed with treatment.

Conversation prompt: "Do you have questions about how much of the cost your insurance will cover?" (Then, assist them in navigating any potential barriers.)

4. Stay up to date onpatient assistance programs and other resources for affordability

Pharmaceutical companies often offer patient assistance programs that provide significant relief. Keep track of those most frequently used in your practice and support patients through the prior authorization process.

Conversation prompt: "There may be a patient assistance program available from the manufacturer of this drug. There are certain criteria required to qualify for the program. Would it be helpful to review those with you?”

5. Discuss financing opportunities

Some private practices, particularly those offering treatments not fully covered (or not covered at all) by medical, prescription, or dental benefits, offer payment plans and other financing options to make therapy more affordable.

When patients know there’s flexibility in payment, it eases the stress of managing large bills. Bringing up financing options, whether through a third-party solution or an in-house payment plan, can make treatment more accessible, encouraging patients to move forward without fear of immediate financial strain.

Conversation prompt: "Did you know you can apply for financing options if your health insurance benefits don’t cover this treatment?"

Discussing affordability is essential to patient-centered care, especially in today’s tough financial climate. When we have open conversations about cost, we can ease the pressure on patients and help them get the care they need as quickly as possible.

Colin Banas, MD, MHA, is the Chief Medical Officer of iPrescribe by DrFirst.