MAY 2018 ON HEALTH CONSUMER REPORTS 11 CR.ORG/HEALTH  H  ave you ever discussed costs with your doctor? Nearly 1 in 3 Americans feels financially bur- dened by medical expenses, according to BMC Health Services Research. But many people hesitate to bring up the subject, unsure about when and how to do so, or concerned it will negatively affect their care. A 2017 nationally representa- tive Consumer Reports survey of almost 1,200 adults who were taking prescription medication revealed that less than one- third had talked about drug costs with the practitioner who prescribed most of their medication in the preceding 12 months. Many doctors also avoid bringing up the subject. That’s partly because they fear it may offend and partly because they lack ready access to details such as their patients’ medication co-payments. But talking about costs can actually help you save money. For instance, a study that looked at cancer care found that 57 percent of the people who said they discussed treatment prices with their doctors reported lower out-of- pocket costs as a result. Here’s why it’s essential to start having these frank con- versations, and how to start. YOUR DOCTOR CAN OFFER IDEAS A 2016 analysis published in the journal Medical Decision Making found that doc- tors are able and willing to offer a num- ber of cost-saving strategies. For instance, they can switch you from a brand-name drug to the generic equivalent, and may be able to change the dosage or frequency of your medication, reduce the number of drugs you take, or help you find a medica- tion with a lower co-pay. They may also be able to defer some medical tests until you’ve met your de- ductible, schedule follow-up appoint- ments farther apart, communicate more through portals or by phone, or even offer discounts or payment plans. Proactive Patient IT MAY MAKE YOUR CARE BETTER A study presented at the 2017 meeting of the American Society of Clinical Oncol- ogy found that many people worry that expressing financial concerns might in- fluence their doctor’s decisions, leading them, for example, to suggest less effec- tive treatments. It’s a sentiment I’ve heard from patients before. But if your doctors are informed when cost matters, they can make more thoughtful choices. The treatments they recommend are often the result of habit— and costs were never included in their medical training. They can usually select alternative courses of action that are just as effective. STAYING QUIET CAN BACKFIRE But making cost-cutting decisions with- out your doctor’s input can be harmful. According to the CR survey, about 1 in 10 people took expired medication in order to save money, cut their pills in half without being told to do so by their doc- tor, or replaced medication with an over- the-counter drug, herbal supplement, or nondrug treatment. And some consumers cut costs on such necessities as groceries. The survey also found that after learning that the price of a medication had gone up, 1 in 5 people left the prescription unfilled. It’s no surprise that higher prescrip- tion “abandonment” rates at pharmacies are related to higher out-of-pocket costs. But failing to take drugs as prescribed for chronic conditions like hypertension or diabetes, for example, could lead to dangerous health consequences, such as heart attacks or strokes. And a doctor who is unaware that you’re skipping the medication listed in your chart may think the drugs aren’t working and is likely to increase dos- ages, change the medication, or make other unwise treatment decisions. He or she is also likely to recommend more tests or admit you to a hospital unnecessarily. WHEN TO SPEAK UP The time to bring up costs is when your doctor mentions a new prescription, test, treatment, referral, or hospitalization, and concerns about payment enter your mind. Here are some questions to ask. (Your doctor or office staff may not have all of the answers but may be able to di- rect you to other helpful resources.) How much will this cost me? Will it be covered by my health insur- ance, and if so, how much will I have to pay out of pocket? Are there equally good alternatives if I can’t afford to pay for it? Are there any programs to help consum- ers like me defray these costs? Talking Costs WithYour Doctor You may hesitate to bring up the price of treatments, but with out-of-pocket expenses rising, it’s more important than ever Research suggests that   doctors are willing   and able to offer cost-  saving strategies. ORLY AVITZUR, M.D., M.B.A., is Consumer Reports’ medical director. Board-certified in neurology, she is a fellow of the American Academy of Neurology, a clinical instructor at the Yale University School of Medicine, and a medical consultant to the New York Rangers hockey team. ILLUSTR ATION: EDMON DE HARO CRoH05_Proactive_Patient_Doctor_Costs [P]_126902.indd 11 3/12/18 12:46 PM