title: Physicians' perceived knowledge of and responsibility for managing patients' out-of-pocket costs for prescription drugs.
abstract: BACKGROUND
  Most insurers in the US have implemented incentive-based formularies that rely on out-of-pocket costs to influence prescription drug utilization. Medicare Part D plans have broadly adopted such benefit designs.
  
  
  OBJECTIVE
  To evaluate physicians' perceptions of their knowledge of formularies and out-of-pocket costs, factors that influence knowledge of costs, physicians' perceived responsibility for helping patients manage their out-of-pocket costs for prescription drugs, and physicians' perceptions of the role of pharmacists in managing these costs.
  
  
  METHODS
  A multiple-choice survey was mailed to a random sample of 1200 physician members of the California Medical Association; a phone survey of nonresponders was then conducted.
  
  
  RESULTS
  Of 1027 surveys delivered to correct addresses, 509 (49.6%) responses were received. Thirty-three percent of physicians reported that they were usually or always aware of patients' formularies and 20% were usually or always aware of patients' out-of-pocket costs for medications. Surgeons, emergency department physicians, and physicians that prescribe from more formularies than other physicians are less likely to be aware of patients' out-of-pocket costs, while physicians in large practices and those who use computers to prescribe are more aware. While 91% of physicians agreed that it is important that patients' out-of-pocket costs be managed, 40% somewhat or strongly agreed that it is their responsibility to help. Sixty-five percent of physicians believed that it is the responsibility of the pharmacist to be familiar with patients' out-of-pocket costs.
  
  
  CONCLUSIONS
  Physicians often lack the knowledge to assist patients in the management of their out-of-pocket costs for prescription drugs and they depend on pharmacists to help patients manage those costs. Computer order entry and resources available in large physician organizations improve physicians' awareness of out-of-pocket costs when prescribing.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120-1613, USA. wshrank@partners.org
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: George J
authors.initials: GJ
authors.lastname: Joseph
authors.forename: Henry N
authors.initials: HN
authors.lastname: Young
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: Yelena
authors.initials: Y
authors.lastname: Kholodenko
authors.forename: Peter
authors.initials: P
authors.lastname: Glassman
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011306:Prescription Fees; D012941:Social Responsibility