It seems that everyone’s talking about the high costs of drugs—to friends, with family, on social media—but where those conversations are not happening often enough is at the doctor’s office. Despite the clear toll of high drug costs, a Consumer Reports Best Buy Drugs nationally representative telephone poll of more than 2,000 adults who take a medication found that, despite the clear toll of rising Rx prices, only 6 percent of people currently taking a prescription drug found out about the cost of their new medication during a doctor’s visit, when the pre­scription was being written. In fact, 63 percent didn’t learn the price of the drug until they were standing at the pharmacy counter.

And considering that doctors prescribed an estimated 4.4 billion drugs last year, not talking about a patient’s ability to pay can be an ex­pensive oversight.

Patients Lead the Conversation on Costs . . . Not Doctors

When costs were dis­cussed, patients are the ones who stepped up. In our poll, of those who did talk about Rx prices with their doctor (25 percent) most told us that they initiated the conversation, not their doc­tor. And doctors report the same: Our April 2016 poll of 200 internal medicine doc­tors revealed that a majority said that in a typical week they discuss drug costs and affordability with just 2.6 out of every 10 patients.

“The ability to afford a medication can have a huge effect on patient compliance,” says Consumer Reports Chief Medical Adviser, Marvin M. Lipman, M.D. “If there are no less costly alternatives, the doctor should go to bat with the insurance company or the drug’s manufacturer on behalf of the patient.”

Still, some doctors said in our poll that they try to help pa­tients cut costs by prescrib­ing generics or switching to a less expensive alternative. While doctors say they are concerned about affordability, when it comes to treatment decisions, they were more likely to consider efficacy and safety than affordability, suggesting reluctance on the part of doctors to engage in more substantial conversations about costs with patients. When asked to name the leading reason restricting their conversations about costs with patients, at least half of doctors said that they can’t easily access cost information for each patient and don’t have time to find it.

An infographic about Rx prices

Doctors Acknowledge the Patients’ Heavy Burden

Recognizing the financial strain on U.S. consum­ers, the American College of Physicians (ACP), the second-largest physicians group in the country, de­cided it was time for doctors to talk about costs on a na­tional level. Last March the ACP published a position paper, taking the unusual step of wading into the pric­ing debate because doctors are increasingly finding that Rx prices are eclips­ing other health worries for patients, says ACP President Wayne Riley, M.D. "Patients and their families are clearly struggling with the costs of even routine medications. Pharma must be more responsive to this problem or there will be stronger pleas from many for mandated transparency, price controls, and more regulation.”

As for the doctors we polled, large numbers were hopeful that they can make costs a part of the conversation going forward; roughly two-thirds said they were “very” or “somewhat likely” to incorporate a discussion about affordability with patients in the next 12 months.

The Way To Save On Your Prescription Drugs: Speak Up

Editor's Note: This article also appeared in the August 2016 issue of Consumer Reports magazine.

Funding for the preparation of this article was provided in part by the Atlantic Philanthropies and by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumerfraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).