Skip to main content

Patient-provider communication about medication cost in rheumatoid arthritis



To examine the perceived importance and frequency with which out-of-pocket medication costs are discussed between rheumatologists and patients with rheumatoid arthritis (RA) in Canada.


A cross-sectional online survey was distributed to patients with RA and rheumatologists; both were asked to rate their perceived importance of discussing medication costs, and how often these discussions occurred. Predictors of (1) patients discussing costs with their rheumatologist and (2) the perceived importance of discussing medication cost for patients were explored.


Seventy-eight patients and 64 rheumatologists completed the survey; 68% patients and 75% of physicians rated the perceived importance of discussing medication costs as “quite” or “very important”; 22% of patients reported never talking about medication cost, but no physicians reported never discussing costs with patients. The only predictor of talking about cost among patients (at 10% level) was whether they perceived it as highly important (p = 0.058). Higher perceived importance of discussing out-of-pocket costs was associated with a more positive attitude to shared decision-making (p = 0.044).


Discussions about cost do not always happen, even with diseases with potentially high medication costs like RA. Cost was more likely to be discussed by patients who perceived it as “very important,” suggesting the onus might be on patients to initiate these conversations. Without any significant predictors regarding what may make physicians more likely to think it was important to discuss medication costs, there is a need to reinforce recommendations that all physicians seek to discuss costs with all of their patients when suggesting medications.

Key Points

• There is a need for patients and physicians to discuss costs in the treatment decision-making process. Our findings suggest this does not always happen.

• Among patients, medication cost was more likely to be discussed by those who perceived it as “very important” and higher perceived importance of discussing out-of-pocket costs was associated with a more positive attitude to shared decision-making.

• Our results did not reveal any significant predictors regarding what may make physicians more likely to think it was important to discuss medication costs, suggesting that there is a need to reinforce recommendations that all physicians seek to discuss medication costs with all of their patients when suggesting medications.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. Singh JA, Saag KG, Bridges SL, Akl EA, Bannuru RR, Sullivan MC et al (2016) 2015 American College of Rheumatology Guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol Hoboken 68:1–26

    Google Scholar 

  2. Finckh A, Deane KD (2014) Prevention of rheumatic diseases: strategies, caveats and future directions. Rheum Dis Clin N Am 40:771–785

    Article  Google Scholar 

  3. Canadian Institute for Health Information (2016) Prescribed drug spending in Canada, 2016: a focus on public drug programs. CIHI, Ottawa

    Google Scholar 

  4. Eisenberg Center at Oregon Health & Science University. Choosing medications for rheumatoid arthritis: clinician’s guide. Comp Eff Rev Summ Guid Clin [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 [cited 2018 Jun 24]. Available from:

  5. Mukherjee K, Kamal KM (2017) Sociodemographic determinants of out-of-pocket expenditures for patients using prescription drugs for rheumatoid arthritis. Am Health Drug Benefits 10:7–15

    PubMed  PubMed Central  Google Scholar 

  6. Law MR, Cheng L, Dhalla IA, Heard D, Morgan SG (2012) The effect of cost on adherence to prescription medications in Canada. CMAJ Can Med Assoc J J Assoc Medicale Can 184:297–302

    Article  Google Scholar 

  7. Hennessy D, Sanmartin C, Ronksley P, Weaver R, Campbell D, Manns B et al (2016) Out-of-pocket spending on drugs and pharmaceutical products and cost-related prescription non-adherence among Canadians with chronic disease. Health Rep 27:3–8

    PubMed  Google Scholar 

  8. Wolfe F, Michaud K (2009) Out-of-pocket expenses and their burden in patients with rheumatoid arthritis. Arthritis Rheum 61:1563–1570

    Article  Google Scholar 

  9. Law MR, Cheng L, Kolhatkar A, Goldsmith LJ, Morgan SG, Holbrook AM, Dhalla IA (2018) The consequences of patient charges for prescription drugs in Canada: a cross-sectional survey. CMAJ Open 6:E63–E70

    Article  Google Scholar 

  10. Sabaté E, World Health Organization, editors (eds) (2003) Adherence to long-term therapies: evidence for action. World Health Organization, Geneva

    Google Scholar 

  11. Vera MAD, Mailman J, Galo JS (2014) Economics of non-adherence to biologic therapies in rheumatoid arthritis. Curr Rheumatol Rep 16:460

    Article  Google Scholar 

  12. Patel MR, Wheeler JRC (2014) Physician–patient communication on cost and affordability in asthma care. Who wants to talk about it and who is actually doing it. Ann Am Thorac Soc 11:1538–1544

    Article  Google Scholar 

  13. Alexander GC, Casalino LP, Meltzer DO (2003) Patient-physician communication about out-of-pocket costs. JAMA. 290:953–958

    Article  Google Scholar 

  14. Harrison M, Bansback N, Aguiar M, Koehn C, Shojania K, Finckh A et al (2020) Preferences for treatment to prevent rheumatoid arthritis in Canada and the influence of shared-decision-making. Clin Rheumatol.

  15. Barr PJ, Thompson R, Walsh T, Grande SW, Ozanne EM, Elwyn G (2014) The psychometric properties of CollaboRATE: a fast and frugal patient-reported measure of the shared decision-making process. J Med Internet Res 16:e2

    Article  Google Scholar 

  16. SAS 9.4. North Carolina, USA: SAS (2012)

  17. Hall J, Julia Kaal K, Lee J, Duncan R, Tsao N, Harrison M (2018) Patient satisfaction and costs of multidisciplinary models of care in rheumatology: a review of the recent literature. Curr Rheumatol Rep [Internet]. [cited 2019 Jul 17];20. Available from:

  18. Blumenthal-Barby JS, Robinson E, Cantor SB, Naik AD, Russell HV, Volk RJ (2015) The neglected topic: presentation of cost information in patient decision aids. Med Decis Mak 35:412–418

    Article  CAS  Google Scholar 

  19. Canadian Institute for Health Information (2016) National Health Expenditure Trends, 1975 to 2016. CIHI, Ottawa

    Google Scholar 

  20. Goldsmith LJ, Kolhatkar A, Popowich D, Holbrook AM, Morgan SG, Law MR (2017) Understanding the patient experience of cost-related non-adherence to prescription medications through typology development and application. Soc Sci Med 194:51–59

    Article  Google Scholar 

  21. Bansback N, Phibbs CS, Sun H, O’Dell JR, Brophy M, Keystone EC et al (2017) Triple therapy versus biologic therapy for active rheumatoid arthritis: a cost-effectiveness analysis. Ann Intern Med 167:8–16

    Article  Google Scholar 

  22. Barber CEH, Jewett L, Badley EM, Lacaille D, Cividino A, Ahluwalia V, Averns H, Baillie C, Ellsworth J, Pope J, Levy D, Charnock C, McGowan C, Thorne JC, Barnabe C, Zummer M, Lundon K, McDougall RS, Thomson JG, Yacyshyn EA, Mosher D, Brophy J, Ruban TN, Marshall DA (2017) Stand up and be counted: measuring and mapping the rheumatology workforce in Canada. J Rheumatol 44:248–257

    Article  Google Scholar 

  23. Campbell DJT, Manns BJ, Soril LJJ, Clement F (2017) Comparison of Canadian public medication insurance plans and the impact on out-of-pocket costs. CMAJ Open 5:E808–E813

    Article  Google Scholar 

Download references


This research was funded by a 2015 Canadian Initiative for Outcomes in Rheumatology cAre (CIORA) grant. Mark Harrison is supported by a Young Investigator Salary Award 2016 from The Arthritis Society (YIS-16-104) and a Michael Smith Foundation for Health Research Scholar Award 2017 (#16813).

Mark Harrison held the UBC Professorship in Sustainable Health Care, which between 2014 and 2017 was funded by Amgen Canada, AstraZeneca Canada, Eli Lilly Canada, GlaxoSmithKline, Merck Canada, Novartis Pharmaceuticals Canada, Pfizer Canada, Boehringer Ingelheim (Canada), Hoffman-La Roche, LifeScan Canada, and Lundbeck Canada.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Mark Harrison.

Ethics declarations

Conflict of interest

MHa and MHu report grants from CIORA during the conduct of the study. All other authors have nothing to disclose.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kaal, K.J., Bansback, N., Hudson, M. et al. Patient-provider communication about medication cost in rheumatoid arthritis. Clin Rheumatol 40, 93–100 (2021).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Communication
  • Medication cost
  • Patient-centered
  • Rheumatoid arthritis