Family Webicine

By Rod Moser, PA, PhD

It happens all of the time. An ill patient makes an appointment, is examined, and is diagnosed. The medical provider gives them a prescription (or sends it to the pharmacy electronically) and expects the patient to pick it up and take it as directed. Guess what? According to one study by a pharmaceutical company, nearly 80% fail to pick it up. Some patients even know at the time of the visit that they have no intention of getting the prescription filled. The medical provider is never informed of this. Personally, I feel that 80% is way too high of a percentage.

I started to ponder the possible reasons. The first thing that comes to my mind is money. Some people with insurance have such high deductibles – $5000 or more – that any prescription is like paying out cash; cash that they may not have. The cost of medications can be astronomical, depending on what your medical provider prescribes. Some prescriptions are actually more costly than the medical visit. A person paying out-of-pocket for a medical visit (about a hundred dollars) may not have another hundred dollars to spend on medication, so they decide to just “wing it”.

I make it a point with every visit to get an understanding of the patient’s financial situation, such as their insurance coverage. I always try to be cost effective (my old HMO training), prescribing generics or the least-expensive drug that will do the job. If I know a person is paying cash, I will steer them toward discount pharmacies or large chain stores that advertise five-dollar prescriptions. We are seeing fewer and fewer pharmaceutical reps in our office, so consequently, we are getting fewer and fewer medication samples; samples that I would often use to reduce the cost of the written prescription, or eliminate the need to go to the pharmacy all together.

Instead of samples, some pharmaceutical companies are providing coupons for reduced cost or to pay the co-payment. Depending on the medication, a brand-name pharmaceutical could require a $50 co-pay. My pharmacist friend tells me that several people walk away from his counter every day once they find out the cost of their prescription and many never show up and their prescriptions have to be returned to stock.

I find it troubling that a child, diagnosed with pneumonia, may not get their prescription if a parent has limited financial resources and also must buy groceries and gasoline on the same day; or that a parent diagnosed with symptom-free high blood pressure will not get the prescription because they cannot afford it.

Another reason a person may not pick up their prescription is their disagreement with the diagnosis and treatment plan. A person can come in with respiratory illness expecting an antibiotic. Since the vast majority of respiratory illnesses are viruses, which do not respond to antibiotics, the clinician may not (and should not) prescribe an antibiotic. Many people with high blood pressure are in total denial that this is a problem, so they simply ignore the treatment regime and do not get the prescription filled. Anytime there is a disagreement in expectations—a patient is expecting one treatment or a specific medication and a medical provider doesn’t meet that expectation—there is going to be an issue.

Some people will simply delay getting a prescription filled. As clinicians, we often assume that they are going to leave our offices and go directly to the pharmacy, but many will decide to wait a day or so. If they wake up the next day feeling better, they may never pick it up. Transient symptoms, like vomiting or diarrhea, often resolve before a person gets their prescription, so if the problem has resolved, there is really no need for medications. It seems that prescriptions for pain medications always get promptly filled.

When I order a lab test, I will eventually be notified by the lab if the patient never shows up. Granted, it may be a month after I ordered it, but at least I know they never complied. This is not the same for prescriptions. I never know if (a) the person picked up their prescription, or (b) picked it up and only took half of it, or (c) picked it up and gave it to someone else. Unless a medical group has an in-house pharmacy, the clinician will never know if a prescription was filled or not.

Having medical care is a partnership. If your doctor prescribes a medication for a certain medical condition, it would be in your best interest to take it. If you have no intention whatsoever of getting it filled, tell the medical provider up front, and give them a reason.  If you are having financial difficulties or have really, really bad insurance, inform your medical provider so he or she can prescribe appropriately. If you have any questions or concerns regarding a prescribed medication, address it at the time of the visit.