Briana Scurry pawning her Olympic medals to pay her medical bills is an example of “financial toxicity,” a term that describes the hardships people face when significant portions of their budgets go toward medical expenses, particularly prescription drugs.

About one in five prescriptions is never claimed at pharmacies, according to the U.S. Centers for Disease Control and Prevention, and it's often because the patients can't afford the medication—a fact they may not want to admit to their doctors. “No drug you can't pay for is going to work,” says A. Gordon Smith, MD, FAAN, chair of the neurology department at Virginia Commonwealth University in Richmond.

Many people are reluctant to talk about their financial limitations, perhaps out of embarrassment, although their medical conditions could get worse if they don't fill their prescriptions or they avoid doctor visits or ration medication to save money. Dr. Smith encourages patients to speak openly and honestly with their physicians, as it is the best way to begin addressing any problems.

“Doctors' offices should be safe, nonjudgmental spaces where patients feel comfortable talking about their financial situations,” he says. “In some instances, we may be able to change therapies based on affordability.” Doctors also may be able to refer patients to financial assistance programs or reduced-price prescription services such as GoodRx and Cost Plus Drugs.

Jason L. Crowell, MD, a neurologist at the Norton Neuroscience Institute in Louisville, KY, had a patient who saw him for a second opinion after her first doctor suggested she take a drug with an out-of-pocket monthly cost of $1,000. Dr. Crowell told her he wouldn't prescribe the medication for her because even if it were effective, it wouldn't improve her symptoms more than 5 percent.

“That might change the calculus of what someone is willing to pay,” says Dr. Crowell. “It's important for patients to know that it's acceptable to ask about treatment costs. In some cases, the benefits may not justify proceeding.”

Dr. Crowell says he might advise patients to stick with an older drug even if pharmaceutical manufacturers start marketing an “upgrade” (such as a new time-release version) if it can save them a significant amount of money. “A new Parkinson's medication may be slightly more effective at a much higher cost than one currently available,” he explains. “But if the ‘older' drug is still reasonably good, then we should pause to ask: Is making a change really worth it?”

The nonprofit Institute for Clinical and Economic Reviewicer publishes reports analyzing the cost-effectiveness of prescription drugs that, while written for medical professionals, can help patients make decisions. And patients can take action themselves, says Dr. Smith, who urges them to learn more about organizations that lobby for pricing reform. “Every patient has the right to the most effective therapy for their disease,” says Dr. Smith. “And income and zip code should not determine access.”

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