How to talk to your doctor about medicine costs

Cost-related non-adherence — skipping doses, splitting tablets, delaying refills — is a well-recognised clinical problem. From the prescriber's side it is often invisible: the prescription was issued, so treatment is assumed to be happening.

That invisibility causes real harm. A clinician seeing uncontrolled blood pressure may escalate to a stronger, more expensive regimen when the actual problem was that the first prescription was never affordable.

Pick whichever fits your situation. Being specific about the number is what makes these work.

• Opening: "Before we finalise this, I want to be honest that cost is a real constraint for me. My realistic budget is about X per month. Can we build the plan around that?"
• Requesting substitution: "Is there a medicine with the same active ingredient, or in the same class, that costs significantly less and would work for my situation?"
• Asking about necessity: "Of everything on my list, which are essential, which are optional, and is anything duplicated?"
• Simplifying: "Could any of these be combined into a single tablet, or given as a longer supply to reduce the per-dose cost?"
• Checking monitoring: "If we switch, what extra monitoring do I need and when should we review?"
• Already struggling: "I have been making this last longer than prescribed because I could not afford a refill. I want to fix that properly."
• Assistance: "Does this manufacturer run a patient assistance programme, and can your office help me apply?"

Agree the specifics in the room. Ambiguity is what causes switches to go wrong.

1. 1Which medicine is changing, and to what exact product and strength.
2. 2Whether anything else stays the same.
3. 3What to monitor at home and how often.
4. 4Which symptoms mean 'contact us immediately'.
5. 5The review date, booked before you leave.
6. 6Who to contact if the new option turns out to be unavailable.