Medication affordability discussions with older adults in primary care

INTRODUCTION: Cost is a major barrier to medication accessibility. While a minority of adults experience problems affording their medications, older adults are particularly vulnerable due to increased polypharmacy and fixed incomes. Clinicians can help reduce cost-related non-adherence and improve medication affordability; however, opportunities to improve affordability are often missed due to failure of the patient or clinician to discuss the issue. OBJECTIVE: Identify the incidence and resolution of cost-related conversations between patients and clinicians during primary care visits. METHODS: We conducted this quality improvement project at a primary care office. Student pharmacists observed in-person encounters with patients ≥65 years of age and documented the incidence of cost-related conversations and who initiated the conversation. After the visit, they asked if the patient had affordability issues. Patients and clinicians were blinded to the study purpose and hypothesis. RESULTS: Students observed 79 primary care visits. Cost conversations (medication or non-medication related) occurred in 37% (29/79) of visits. Having concerns about affordability did not impact the likelihood of conversation about non-medication related healthcare costs (RR = 1.21 95% CI 0.35–4.19, p = 0.67) or medication related costs (RR = 0.86 95% CI 0.13–5.65, p = 1.0). CONCLUSION: Our results indicated that cost conversations did not routinely occur at our site. Failure to discuss costs, especially for patients with underlying cost concerns, may lead to cost related non-adherence and worse outcomes.