US Physicians Have Difficulty Estimating Patients’ Out-of-Pocket Medication Costs

Physicians in the US were found to have difficulty in determining patients’ out-of-pocket medication expenses, even with access to their drug and insurance information, according to findings from a survey published in JAMA Network Open.

A national mail-in survey was sent to 900 outpatient physicians across the US in December 2019. The ability to estimate out-of-pocket costs was assessed using a short vignette, in which a hypothetical patient was prescribed a new tier-4 drug that costed $1,000 per month without insurance. A summary of the patient’s private insurance information was also provided. Physicians were asked to estimate how much the patient would have to pay when filling this medication using 4 types of cost-sharing: deductibles, co-insurance, copays, and out-of-pocket-maximums.

Multivariate linear regression was used to assess differences in cost estimation performance by medical specialty and demographic characteristics. Data were also collected on physicians’ attitudes toward discussing medication costs with patients; regression models were further adjusted for these factors.

Of the 900 physicians contacted, 405 (45%) responded to the survey: 112 (30%) primary care physicians, 128 (35%) were gastroenterologists, and 131 (35%) were rheumatologists. Mean age of participants was 49±10 years; 220 (59%) were men; and 216 (58%) were White.

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Overall, 192 (52%) physicians accurately estimated medication costs before the deductible was met; 228 (62%) accurately used coinsurance information to estimate costs after the deductible was met; 224 (61%) accurately used copay information; and 210 (57%) accurately estimated costs after out-of-pocket maximum was met.

The average number of correctly answered questions was 2 out of 4. A total of 78 (21%) participants provided correct estimates for all 4 cost-sharing types.

Ability to estimate costs was not significantly associated with any demographic characteristic or any specific attitude toward discussing medication costs. The majority of physicians (74%) agreed that physicians have “an obligation to…[discuss] out-of-pocket costs when writing orders.” However, 77% indicated that they had difficulty advising patients on out-of-pocket costs, often due to time constraints (76%) or lack of knowledge (69%).

Data from this study suggest that while most physicians believed discussing medication payments with patients is important, few of them were able to accurately estimate out-of-pocket costs.

Researchers noted that data from physicians in specialties outside of primary care, gastroenterology, and rheumatology were not collected. In additions, shutdowns related to the COVID-19 pandemic may have affected response rates, potentially introducing nonresponse bias.

“These findings suggest that increased price transparency and simpler insurance cost sharing mechanisms are needed to enable informed cost conversations at the point of prescribing,” the researchers wrote.


Sloan CE, Millo L, Gutterman S, Ubel PA. Accuracy of physician estimates of out-of-pocket costs for medication filling. JAMA Netw Open. 2021;4(11):e2133188. doi:10.1001/jamanetworkopen.2021.33188

Source: Medical Bag

General Practice Management