Many chronically ill patients never tell their doctor or nurse they’ve had to cut back on prescription drugs because they are too expensive, and many physicians never ask if the drugs are unaffordable, a study said on Monday.

“This study suggests that most patients who fail to alert clinicians about their medication cost problems are not asked about their ability to pay for their medication, and many perceive that clinicians are unwilling or unable to help them with this problem,” said the report from the University of Michigan.

“As drug costs continue to escalate and the number of adults with chronic illnesses grows, it will be increasingly important for health care providers to take an active role in discussing patients’ medication cost problems and appropriate strategies for addressing them,” it added.

The study was based on a survey of 600 chronically ill U.S. adults with an average age of 62 who said they had underused medication in the preceding 12 months because of cost concerns.

The report, published in the current issue of the Archives of Internal Medicine, found that two in three patients did not tell their doctor or nurse that they intended to cut back on their medication because they couldn’t afford it.

Of those who did not disclose their intentions, 66 percent said they had not been asked about their ability to pay.

Of all the patients surveyed, only 30 percent said they had been told about programs to help pay drug costs and only 28 percent were told to substitute less expensive drugs. The authors of the study said those with chronic illnesses often take a combination of drugs and are placed under financial stress because of it.

Previous research has found that reduced use of drugs to lower cholesterol, treat heart problems, control asthma and other conditions has been linked to increased emergency room visits, nursing home admissions and other problems, it said.

The research was funded by the U.S. government’s Department of Veterans Affairs and the Agency for Healthcare Research and Quality.

In an editorial in the same journal commenting on the study, Alex Federman, a physician at Mount Sinai School of Medicine, New York, said: “greater cost-sharing and higher prices for medical care will increasingly drive patients to forgo medications and other services.”

As a result, “physicians have a greater responsibility to direct patients to sources of assistance with health care costs when help is needed, and to select affordable therapies whenever possible,” he added.

SOURCE: Archives of Internal Medicine, September 13, 2004.