Many experts agreed that the new regulation would have little to no effect on consumer purchasing or on lowering drug prices, largely because patients have limited drug options and need these drugs to survive.14,15 Yet, some experts contend that it had the potential to act as an  opportunity for patients to better understand the pharmaceutical landscape and would have facilitated more physician-patient cost-of-care conversations.15

“Even for the patient with insurance who only has to pay a low fixed copay, the disclosure of the list price is educational to patients wondering why their health plan premiums are rising so quickly. Some patients will be swayed to ask about alternatives if they know the price is high and prescribers seeing the same ads will also be more aware of the price,” said C. Michael White, PharmD, a pharmacist and professor at the University of Connecticut School of Pharmacy.15

Barriers to Cost-of-Care Conversations

Cost of care and financial toxicity do not just refer to the price tag of drugs, treatments, or diagnostic tests. It also encompasses a variety of indirect costs such as missed work, income loss, disability, transportation, and childcare expenses.1,6 The sensitivity of discussing such topics may make some clinicians apprehensive. In addition, healthcare providers may have difficulty identifying if a patient is suffering with financial distress. 1,6,19 A recent study presented at the 2019 ASCO Annual Meeting suggests that some patients, particularly those with annual household incomes of less than $50,000, are more interested in having cost-of-care conversations than other patients.20

Many physicians may also feel ill-equipped to discuss alternative cost-reduction strategies due to a lack of awareness of patient-specific financial and personal situations, resources for mitigating patient-specific costs, and alternative treatments to aid in such cost-reduction.1,6,19 Additionally, physicians may only have a limited amount of time with patients, which may inhibit the rapport needed to discuss patient-specific financial toxicity concerns. As such, physicians may designate nurse navigators or nonmedical staff to conduct cost-of-care conversations.1,4,21

In a 2019 study, Maria Pisu, PhD, and colleagues made the surprising discovery that some patients preferred having cost-of-care conversations with nurses or nonmedical staff largely because these healthcare professionals were viewed as having more time to commit to conversations, which may become lengthy and personal.21 Designating a specific member of the staff to handle cost-of-care conversations also ensures that this person can be well versed in available patient resources, current drugs, and potential cost-reduction strategies.

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Resources for Healthcare Providers

The American College of Physicians (ACP) has developed a number of free online resources to aid healthcare professionals and patients with cost-of-care conversations. One such tool, the “Cost Distress Screening Tool,” can tactfully aid healthcare providers in identifying patients with potential financial distress. The ACP’s resource, “Cost of Care Resources for Clinicians and Patients,” helps providers identify potential solutions once a distress about a treatment cost is identified. Furthermore, the ACP tool, “Medical Treatment Cost Planning,” provides a comprehensive outlook of an entire treatment plan including medical and nonmedical costs for both providers and patients. Additional ACP resources include instructional videos for healthcare providers on how to initiate and navigate cost-of-care conversations.6

The America’s Essential Hospitals association also provides a number of free resources in their online library (TalkCostofCare.org). The practice briefs provided in this tool are particularly helpful in providing methods to improve cost-of-care conversations.6 Dr Pisu’s report also provides sample sentences based on direct patient quotes that reflect how patients would like providers to approach such discussions.21