How to Start a Cost Conversation With Your Patients

Cost conversations with patients are increasingly important, as healthcare costs in the U.S. continue to rise. Prescription medication costs, in particular, are a barrier to treatment. About 1 in 5 Americans with Medicare or commercial insurance have at least one prescription that is not covered by their insurance, according to research conducted by GoodRx. And nearly a third of people are leaving prescriptions unfilled at the pharmacy due to cost.

There’s no question that increasing costs can cause significant financial burden and emotional distress for patients. And this can adversely affect decision-making and outcomes. So these conversations are necessary. Research suggests cost conversations, especially when facilitated by shared decision-making tools, can have a favorable impact on outcomes. Patient advocacy groups even suggest these conversations should become a standard part of medical care.

So how do you get started? Here are some tips for discussing cost with your patients and things to keep in mind.

Be aware of barriers

To begin, it helps to be aware of the potential barriers to cost conversations. Clinicians and patients have difficulty discussing costs for treatments for different reasons. Let’s look at these more closely. 

Healthcare professionals report the following issues in communicating costs:

• Lack of knowledge regarding prices for treatments or prescriptions

• Insufficient resources to educate patients on costs

• Inadequate training to make these conversations a common practice

• Scarcity of time, and the concern that tackling another difficult subject may take up more of it 

Patients, for their part, say they have the following concerns regarding cost of care discussions:

• Stigma related to the potential inability to pay, or the need to discuss managing costs

• Fear that being unable to pay will reduce the quality of care received 

• Lack of skills or resources to participate in these conversations and find the information they need to make decisions

Take the lead

Many patients are uncertain about how to address the topic of cost, so it can be helpful for their clinician to start the conversation. Know that financial and logistical challenges of medical treatments affect patients of all socioeconomic backgrounds, both with and without insurance coverage. So it’s best not to assume one way or the other.

The American College of Physicians (ACP) suggests taking a direct, nonaccusatory approach to starting cost conversations. For example, you could say, “I’ve heard from patients that the cost of medication is becoming harder to manage,” or “Are you worried about the cost of your care?” It’s important to reassure patients that cost-of-care discussions will not negatively affect the quality of their care.

Taking the time to hear about concerns or hurdles a patient might face (if any) is important. It allows for a more productive discussion about solutions, which could include alternative therapies or approaching different ways of acquiring resources. Note that such conversations also call for a strong level of empathy, reassurance, and openness without judgment to each patient’s situation. 

Utilize ancillary staff

Time is a precious commodity in patient care. So it’s no surprise that it can be a significant barrier to cost-of-care conversations. But it’s important to know that the treating clinician doesn’t necessarily bear the sole responsibility in tackling this problem. Consider leaning on other members of your healthcare team, such as nurses, medical assistants, and financial counselors, for additional patient support. This is especially helpful when they have already built a strong rapport with patients.

It may take some trial-and-error to find the best way to incorporate cost conversations into practice. Perhaps you take this on during medication reconciliation, or a medical assistant begins the conversation during intake. But once you and your staff become accustomed to a process that works for you, it becomes easier over time.

Know your resources

After you’ve initiated the cost conversation, connecting the patient to available resources is the next step. So if cost is a concern for your patients, you can help them by pointing them in the right direction for support.

Reaching out to other organizations in your community can help, if you haven’t already. Other patient advocacy groups might already have your area covered, too. Helpful resources can include:

• Local health clinics

• Local needs navigation teams

• AAFP Neighborhood Navigator

There are also many charitable organizations and foundations with information online that can help with direct and indirect costs, such as:

• Medical supplies

• Screening costs

• Transportation costs

• Caregiver support

The ACP has developed several resources and guidelines for clinicians to effectively hold a structured conversation. These guides serve as fundamental tools for estimating costs and how to discuss them. They include:

• Health cost estimators

• Planning tools

• Printable resources for patients

Cost comparison tools, such as GoodRx, can help you have open discussions on medication costs, while allowing patients to make informed decisions that suit their financial situation. You can also quickly look up drug prices on GoodRx to determine the best place to purchase or if an alternative medication would be more cost-effective.

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Written by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Reviewed by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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