Risky prescription drug practices are on the rise in a grim economy

Sep 27, 2011

Lack of money to pay for medical bills and medications is consistently the top financial concern for Americans, according to findings from an ongoing, monthly Consumer Reports Index survey. And this year especially, financial pressures are leading more people to take potentially dangerous actions with prescription drugs.

In a separate, annual survey over the last three years, the Consumer Reports National Research Center has asked consumers about their medication and health-care use, and about ways that they cut costs. This year, the percentage of people who reported skimping on medication and other forms of health care rose by 9 percentage points from 39 to 48 percent, the largest increase so far.

Of the 2,038 nationally representative adults contacted this year, 49 percent (1,226) said they currently take at least one prescription medicine. (This group formed the basis of our survey.) The average number of drugs people reported taking regularly was 4.5.

Of the people in this group, 48 percent said they took steps to save money, some of them potentially dangerous. They included:

• Putting off a doctor’s visit (21 percent)
• Delaying a medical procedure (17 percent)
• Declining a medical test (14 percent)

Within that same group, 28 percent took significant risks with their medication to save money, including:

• Not filling a prescription (16 percent)
• Taking an expired medication (13 percent)
• Skipping a scheduled dose without asking a doctor or pharmacist (12 percent)
• Splitting pills in half without consent of their doctor or pharmacist (8 percent)
• Sharing a prescription with someone else (4 percent)

Generics are common, but concerns persist

On the positive side, generic drug use remains high. Among those who said they took prescription medication, three of every four of their prescriptions were filled with a less expensive generic drug.

Yet more than a third of respondents (39 percent) said they had a concern about generic drugs or expressed a misconception about them. For example, they thought generics weren’t as effective or safe as brand-name drugs, caused different side effects, or didn’t have to meet the same federal standards.

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.

While a majority of those surveyed said their doctor regularly recommended generic drugs, 41 percent said their doctor only sometimes—or never—recommended a generic.

Many doctors don’t talk with patients about drug costs

Just 5 percent of the respondents said they found out about the cost of a prescribed drug at the doctor’s office. Sixty-four percent discovered it at the pharmacy when picking up the prescription.

“If a patient can’t afford their medication, that’s something his or her doctor needs to know,” says John Santa, M.D., director of the Consumer Reports Health Ratings Center. “But to find out, doctors have to ask.”

“Doctors should think of themselves as stewards of their patient’s care,” he says, “and that includes considering their patient’s ability to pay for treatment.”

Eighteen percent of the respondents said they asked their doctor to prescribe a drug they saw advertised, and 70 percent of those who requested the prescription reported that their doctor complied. The problem is that drug ads usually promote expensive brand-name medication that doesn’t have a cheaper generic version.

Most respondents said they had misgivings about the way doctors prescribe medication and how drug companies might influence their decisions. A majority (85 percent) said they were concerned about drug companies that reward doctors for writing prescriptions for their drugs. And 76 percent said they were worried about doctors who are paid to give testimonials or serve as spokesmen or spokeswomen for drug companies.

Bottom line: If cost is an issue, raise it with your doctor when he or she prescribes a medication, especially one you might have to take long-term for a chronic condition. Ask if there is a generic version. If not, ask if there is a generic drug in the same “class” of drugs that might work as well. Sometimes even a drug in a different chemical class but with a similar therapeutic effect might just do the trick. That is often this case with drugs that treat such common conditions as allergies, diabetes, heartburn, high cholesterol, and osteoarthritis.

Talk with your pharmacist about costs, too. Ask about special discount generic drug programs. Many chain pharmacies offer a month’s supply for about $4 or three months for $10, though restrictions do apply. Your local independent pharmacists might be willing to match those prices.

Finally, avoid free samples when possible. They’re usually for the most expensive medications that don’t have generic equivalents, and that can cost you when it’s time to fill the prescription.

These materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).