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

Overall, 70% selected a price category that was within one ordinal category of the correct price. For the least expensive drugs, however, correctly identifying the drug cost as being within one ordinal category may have indicated that the physician thought the drug cost was double its actual cost. For example, if the unit cost of Halcion was thought to be between $0.51 and 1.00 (ie, answer "B," which is within one ordinal category), the participant may have thought the unit price approximated $1.00, which is more than double its actual cost of $0.46.

No other data involving perceptions of physicians exist with which to compare our data. In a pediatric critical care unit, however, the mean drug cost score was only 46.5% for physicians.[5] Our data do support the current perception of a lack of drug cost awareness among physicians.

The low response rate (30%) and selection bias limit the generalizability of our findings. Selection bias would presume that those individuals who elected to participate did so because they believed they would score well. Additionally, those physicians attending a continuing medical education seminar might be more inclined to stay abreast of other medical matters including drug costs. Both of these selection biases, however, would argue that those who responded had a better chance of scoring higher. Hence, if physicians had been selected randomly in the community, the scores might indeed have been lower than those observed in this study.

It is not known whether the participating physicians had prescribed any of the medications listed on the questionnaire. Presumably, if the physician is not inclined to prescribe a drug, he or she is less likely to be aware of its cost. Therefore, it could be reasoned that a lack of drug cost awareness for that particular medication would be irrelevant. The physician's ability to prescribe an appropriate medication, however, should be based on a general knowledge of all other possible drugs. This involves incorporating efficacy, side effects, and cost data into decision making. Hence, being aware of pertinent information, notably cost data, especially for relatively new drugs (such as those in the questionnaire), should have an impact on physicians' existing prescribing practices either by promoting a change or by reinforcing allegiance to their current drugs of choice.

The availability of cost data has been shown to affect physician behavior. Cost Rounds highlighting the costs of tests, services, and drugs have been shown to reduce health care expenditures following educational intervention.[6-8] Yet availability of medication pricing is not addressed in either the peer-reviewed or promotional literature. Drug cost information is not readily available. Although certain textbooks list drug costs (eg, RedBook, Medical Economics, Montvale, NJ), new drugs, which are the subject of the majority of pharmaceutical advertising, will not be included until the next annual edition is available. Most physicians are not inclined to embark on the time-consuming task of calling a pharmacy for the price of each new product as it becomes available. Additionally, physicians employed at health maintenance organizations or other institutions that have a formulary are unlikely to be aware of drug costs unless they are members of the formulary committee. Thus, it is not surprising that 99% of the participants in our study could not provide accurate cost estimates.