Physician awareness of prescription drug costs: a missing element of drug advertising and promotion

Journal of Family Practice, Jan, 1993 by Lucinda G. Miller, Alan Blum

Drug therapy is a major constituent of medical care for outpatients, with 45% to 75% of office visits resulting in a prescription.[1-3] It has been estimated that medications accounted for 7% of health care costs in 1987 in the United States.[4] Hence, rational drug prescribing that incorporates drug costs as an important determinant in drug product selection is paramount in optimal care. Yet many physicians purportedly are not aware of drug costs. To address this perception, we studied drug cost awareness in primary care physicians attending a continuing education seminar.

Methods

A list of the first 20 prescription drugs advertised in two primary care medical journals (The Journal of Family Practice and American Family Physician) were selected for prescription price awareness analyses. The following drugs were included and are listed in the order of appearance in the journals and on the questionnaire: Voltaren, Wellbutrin, Prozac, Isoptin SR, PediaProfen, Feldene, Verelan, Capoten, Carafate, Axid, Halcion, Cipro, Calan SR, Lorelco, Procardia XL, Cardizem, Tagamet, Suprax, Kerlone, and Ventolin.

A questionnaire was developed listing four price ranges for a single unit of each drug (eg tablet): A: $0.01 to 0.50; B: $0.51 to 1.00; C: $1.01 to 1.50; D: [is greater than or equal to] $1.51. We elected to use the average wholesale price to the pharmacy per unit because prices to the patient vary considerably from pharmacy to pharmacy. The physicians were informed of this distinction verbally and in written text. The physicians were also asked to disclose the following demographic information: (1) age, (2) sex, (3) specialty, (4) board certification, and (5) years in practice. To ensure anonymity, names were not requested.

The questionnaire was administered to 305 registrants of a 5-day family medicine continuing education course at Baylor College of Medicine. The participants were asked to return their questionnaire at the end of the day during which it had been administered. Two days following the administration of the questionnaire, the correct answers were posted for educational purposes but no questionnaires were accepted for return thereafter.

Results

Ninety-two meeting registrants (a 30% response rate) participated in the study. Of the 66 respondents who stated their sex, 14 were female and 52 were male. Twenty-six (28%) did not respond to the sex question. The mean age of the participants was 45.6 years (range: 31 to 72 years). Sixty-nine (75%) of the participants specialized in family medicine. Sixty-seven (73%) were board-certified within their specialty. The responding physicians had been in practice for a mean of 11.7 years (range: 21 to 42 years). Nearly every geographic region in the United States was represented. Eighty-five physicians completed all questions on the questionnaire; seven did not complete the entire questionnaire. For those who did not complete the questionnaire, on average, 2.25 questions were omitted (range: 2 to 4).

The average score on the questionnaire was 37% answered correctly (range: 0% to 75%). Random guessing alone would have produced a 25% correct response rate. The rate of underestimated medication costs was 22% and the rate of overestimation was 41%. Only one participant answered 70% of the questions correctly. He was a 40-year-old, board-certified Texas physician who had been in practice for 3 years.

An equal number of participants correctly identified the most and least expensive medications. Seven (7.6%) participants correctly identified all medications whose unit cost was $1.51 or more (Cipro, Prozac, Suprax, Axid, Procardia XL, PediaProfen, and Feldene) (Figure 1). An additional 35 (38%) participants thought these drugs were in the range of $1.01 to $1.50, not realizing the drugs were more expensive.

At the other end of the spectrum seven (7.6%) participants correctly identified those medications that cost less than 50 cents per unit. These drugs included Halcion, Wellbutrin, Capoten, and Ventolin Rotocaps. Forty-two (46%) participants thought those, drugs were in the range of $0.51 to $1.00. Only 10% correctly identified the price of Wellbutrin; most presumed that the drug cost more. Thus, 67% accurately identified the drug cost within 50 cents for the least expensive drugs.

Physicians were unable to more accurately approximate costs for drugs at either end of the price spectrum. Thirty-six (39.8%) participants correctly identified those medications priced in the intermediate range ($0.51 to 1.50 per unit). This not substantially different from that observed with the least expensive drugs (<$0.50; 21.74%) and with the most expensive drugs (> $1.50; 35%). Overall, 73% and 66% of the physicians' cost estimates were within the correct price category or the next closest price category for the most and least expensive drugs, respectively.

Discussion

In this survey, the majority of physicians could not accurately identify drug costs. Only one physician correctly answered 70% of the questions. Physicians were not more adept at identifying the unit drug cost for the most and least expensive drugs. Only an additional 14 correctly Identified the price range for drugs in the least and most expensive costs ranges. Although the majority of physicians (55% and 57%, respectively) recognized that Cipro and Suprax were, relatively expensive, nearly all (87%) did not recognize that Feldene was also relatively expensive. Furthermore, only 10% recognized the relatively low cost of Wellbutrin; perhaps they assumed that relatively new drugs cost more.