• Integrating Cost-of-Medication Conversations into Primary Care

    Study Description and Methods

    Medication costs represent a significant portion of patient out-of-pocket (OOP) costs. Patients wish that their primary care clinicians would discuss ways to reduce their medications with them. Clinicians are willing to do so but are concerned about time. Viable strategies exist for reducing OOP medication costs including generic substitution, class substitution, pill splitting, 90-day prescribing, stopping medications, and referral to social workers, change in insurance and low cost programs.

    Embedding brief medication affordability questions, (e.g. Is the cost of any of these medications a burden for you?") into the medication reconciliation process provides a means for nursing staff to screen for OOP medication costs. Training nursing staff in screening and training clinicians in actionable strategies for addressing these OOP medication concerns during visits represents viable strategies for workflow integration. Providing prompts and resources for these steps and strategies will reinforce their integration.

    We will recruit five practices and provide them with education, training, and resources. We will adopt rigorous, mixed quantitative and qualitative methods for evaluating our intervention.

    Specific Aims and Objectives

    The primary objective of this project is to assess the feasibility and impact of a team-based approach to promoting cost-of-medications conversations. Our questions are:

    1. Can cost-of-medications screening questions be embedded into primary care clinical workflow?
    2. Can this screening, when supported by clinician and staff training and resources, promote cost-of-medication conversations with patients?
    3. Will these conversations result in medication cost-reduction?
    4. What factors will moderate and mediate these effects?


    December 2016 – March 2018


    In progree/post intervention data collection

    Key Findings and Publications

    Addressing Medication Costs During Primary Care Visits: A Before/after Study of Team-based Training. Jennifer K. Carroll, MD, MPH; Subrina Farah, MS; Robert J. Fortuna, MD, MPH; Angela M. Lanigan, MPA, RD; Mechelle Sanders, BA; Jineane V. Venci, PharmD, MS-CI; Kevin Fiscella, MD, MPH. Ann Intern Med. 2019;170(9_Supplement):S46-S53.

    A Practical Approach to Reducing Patients' Prescription Costs. Kevin Fiscella, MD, MPH, Jineane Venci, PharmD, MS-CI, BCACP, Mechelle Sanders, BA, Angela M. Lanigan, MPA, RD, and Robert J. Fortuna, MD, MPH. Fam Pract Manag. 2019 May-June;26(3):5-9.

    Join Our Online Discussion Community!

    If you are interested in this topic, find our online community on AAFP Connect for updates and resources related to cost of medications conversations. To join, please contact Angie Lanigan at alanigan@aafp.org.

    Contact Information

    For additional information about this study, please contact:

    Jen Carroll, MD, MPH
    Network Director
    AAFP National Research Network
    1-800-274-2237, ext. 6146

    Angie Lanigan, MPA, RDN, LD
    Research Project Manager
    AAFP National Research Network
    1-800-274-2237, ext. 6382

    This study is funded by grants from the Robert Wood Johnson Foundation.