Prescription medication costs never seem to stop soaring. Given that reality, should physicians consider the potential cost to the patient before recommending a drug? And should they give the same consideration to the health insurance company?

It’s easy to assume that most physicians will always recommend drugs based on highest effectiveness, especially if their patient is insured; and that they won’t care about impacts on an insurance company’s finances.

But these off-the-cuff assumptions are wrong, based on responses to a recent Medscape report that presented common ethical scenarios facing physicians. Comments made by survey respondents indicated that many doctors are quite thoughtful about financial impacts not only on their patients but also on third-party payers.

Unaffordable Prescriptions Are Counterproductive

Nearly 4 in 5 physicians told Medscape that doctors ought to consider a patient’s potential out-of-pocket cost before recommending a drug. Their additional comments explained the point emphatically.

“A prescription not filled is worthless,” declared an Oregon emergency medicine physician. “I always check insurance status and while I always prescribe the best medication for the condition, there are often less expensive options. If necessary, I will discuss this with the patient.”

“There is no point in prescribing something that a patient won’t get,” a New Jersey public health doctor agreed. “Adjust the medication, choose generics, or research alternative sources of payment.”

Many physicians said that their peers should research and prepare for a patient discussion that includes both medication options and their potential cost to the patient. “If the patient cannot afford a very costly medicine, you need to be ready to prescribe an alternative so that patient can be treated,” a Florida pediatrician recommended.

That candid conversation with patients “absolutely needs to take place,” an Ohio psychologist agreed. “In this environment of messed-up drug costs and insurance mandates, we should always take this into account.”

But remember, a Colorado pathologist counseled, that although “most over-the-counter and generic alternatives are good and equal” to brand-name drugs, “there are a few that are not. It is the physician’s choice to make a recommendation on which way to go for the patient’s benefit.”

However, not all doctors felt obligated to present patients with a cost-based menu of medication options. “Patients should get the best medicine for their disease,” a Texas neurologist said flatly.

Don’t Always Treat Insurers as the Enemy

When asked about whether to weigh a prescription recommendation’s potential cost on health insurers, not that many more physicians told Medscape no (46% vs 35% yes).

Whereas a California family medicine physician’s philosophy was “take care of the patient — and the payer is not the patient,” many other doctors were more restrained toward insurance companies in their comments.

“A third-party payer is actually pooled resources from patients you cannot see,” said a Michigan internal medicine physician.

An internal medicine doctor in Maryland felt that “economic considerations are important on the prescribing end” for both patients and payers. “It is a way to contribute to some containment of medical costs.”

“If we remain blind to costs and try to live in the ivory tower of medicine, everyone will be affected sooner or later,” a Pennsylvania ob/gyn warned. “There is not an infinite amount of money in the system.”

Physicians should recommend the most effective medication to patients, a Rhode Island doctor said, “and if appropriate, work with the third-party payer to achieve optimum results. We have to stop looking at the payer as the enemy, and they have to be willing to discuss and work better with physicians!”

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