Table 2.

Examples of Strategies to Reduce Out-of-Pocket Costs*

Strategies INVOLVING Care-Plan Changes
Switch to Lower Cost Alternative Therapy or Diagnostic Plan	DR: Need anything else? PT: The one I take for my ulcer…what do you call that? DR: Omeprazole? Zantac? Nexium? PT: Nexium. DR: That’s expensive though. PT: Ain’t no more expensive than the Micardis I have to pay for. DR: How much is that? PT: $150. DR: Why don’t you ask the pharmacist which [peptic ulcer medication] is the least expensive and have him call me.
Switch to Generic Form of Same Medication	DR: I’m going to put you on the generic one, alendronate, which is a cheaper version, but with the same instructions.
Stop or Withhold Intervention	DR: Do you want the tramadol where you could take it as needed for pain? PT: Um, I guess I could try it. I mean I don’t know. DR: We could try 60 of them. It’s a generic, so hopefully the cost would not be bad…if it was bad, you could just say, no, I’ll skip it.
Changing Dose or Frequency of Intervention	PT: Last time I was here, we were going to go with 40 mg of Oxycontin…. We were going to do it three times a day, but that’s not going to work for me. DR: What’s going to work for you? PT: I have to spend $200 on pain medication, that’s how much those pills cost me…. So, I’d rather just go back to the 80s.
Strategies NOT INVOLVING Care-Plan Changes
Changing Logistics of Intervention	DR: For this medication, it’s cheaper to buy it directly from the company, rather than from the pharmacy. [The company] won’t mark it up. They sell it for, I think, $48 a month.
Facilitating Copay Assistance or Charity Care	DR: The copay you have with the Xgeva, there’s supposed to be copay assistance programs and all. Did you look into those?
Free Samples	DR: What are your thoughts? Do you feel it’s best to stay off the Abilify? We can get you samples of it…I don’t want cost to be the issue. PT: Well, that’s the big issue, that’s why I’ve been off of it.
Change or Add Insurance Plans	DR: If you get a secondary coverage, they would pay [for your infusions]. Have you looked into getting a secondary? CG: We’ve called everywhere… PT: Because of my age. DR: You’re too young? CG: Yes. Does the Medicare part D pay for those [infusions]? DR: They pay on the prescriptions…but that’s another good alternative, to get a part D plan. DR: Right now, are you paying for your prescriptions? CG: Yeah. DR: But that’s something that I would definitely consider…is to get on a part D plan.

Fillers (e.g. “um”, “you know”) have been removed from dialogue for brevity and punctuation has been added to improve readability.

Abbreviations: DR. indicates doctor; PT., patient; CG, caregiver.