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Up to 77% of physicians have difficulty advising patients on out-of-pocket costs: 5 findings

Most physicians have difficulty estimating out-of-pocket medication expenses even when they have access to patients' drug and insurance information, according to a study published in November in JAMA Network Open.

The survey provided a vignette in which a hypothetical patient was prescribed a tier 4 drug that cost $1,000 per month without insurance. With a summary of the patient's private insurance information, physicians were asked to estimate how much the patient would have to pay when filling this medication using four types of cost-sharing: deductibles, coinsurance, copays and out-of-pocket maximums.

Of the 371 outpatient physicians included in the study, 112 (30 percent) were primary care physicians, 128 (35 percent) were gastroenterologists and 131 (35 percent) were rheumatologists.

Five findings:

1. Overall, 52 percent of physicians accurately estimated medication costs before the deductible was met; 62 percent accurately used coinsurance information to estimate costs after the deductible was met; 61 percent accurately used copay information; and 57 percent accurately estimated costs after out-of-pocket maximum was met.

2. The average number of questions answered correctly was two out of four.

3. Up to 77 percent of physicians said they had difficulty advising patients on out-of-pocket costs; 76 percent cited time constraints and 69 percent cited a lack of knowledge.

4. Twenty-one percent of participants provided correct estimates for all four cost-sharing types.

5. Determining real-time out-of-pocket costs can be complex, with results of the survey indicating that "increased price transparency and simpler insurance cost-sharing mechanisms are needed to enable informed cost conversations at the point of prescribing," the researchers found.

Click here for more details on the study.

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