Turning provider trust Into a cost conversation

More Americans now worry about affording their prescriptions than at any point since 2018, with 59% of adults saying so in KFF polling published in March 2026. Those concerns are already affecting medication adherence, with roughly 43% of adults reporting that they did not take their medication as prescribed in the past year because of cost. Some took an over-the-counter medication instead, cut pills in half, or skipped doses, while 27% did not fill a prescription altogether.

Vendors and health plans have spent much of the past decade trying to improve treatment adherence by building tools to show patients the cost of their medications. Patients can now choose from insurer portals, benefits apps, discount card sites, and other price comparison services for medication cost information. Yet one of the sources patients trust most for medication guidance, their prescriber, is rarely part of the cost conversation.

Research we conducted this year points to why the gap may still exist. We surveyed 300 adults who take prescription medications about how much they trust each of 12 sources across three topics: prescription cost, medication safety, and adherence to therapies. Prescribers ranked first on medication safety and first on adherence, and 86% of respondents said they would follow a prescriber’s recommendation without checking another source, the highest among all sources surveyed.

Where provider trust slips

Yet, in terms of prescription cost, prescribers ranked only fourth. One of the main contributors to this trust gap may stem, in part, from the fact that these important cost conversations are not occurring. Patients reported that 42% of their providers “rarely or never” discussed what their prescription would cost at the time of prescribing. Independent research points in the same direction: 48% of older adults reported not having enough time to discuss medication costs with their care team, and 43% said the discussion was not easy to understand.

If providers had a complete, timely, and trustworthy data source for all their patients’ potential medication costs at the point of prescribing, they could incorporate cost factors into treatment decisions to help identify more affordable alternatives when clinically appropriate and reduce patients’ financial concerns, all while building trust in the process.

Knowledge builds trust

The information to support cost conversations, real-time prescription benefit (RTPB) data, has been a federally mandated feature within electronic health record (EHR) systems since 2021, yet its impact appears to be minimal. In a 2026 Health Affairs study of 4,894 clinicians across 803 ambulatory clinics, clinicians made a change in response to only 11% of the RTPB alerts they received. Only 4% of the changes involved the medication, while 60% were related to the pharmacy. In other words, simply placing a price alert in the EHR has not been enough to meaningfully change prescribing behavior.

One likely reason for this prescribing inertia is that the price estimates clinicians saw were derived entirely from the patient’s insurance benefit. Other patient options, such as cash-pay, discount cards, and manufacturer assistance programs, were outside the tool’s field of view.

Although insurer websites and apps typically include only RTPB data, those sources ranked first for cost in our survey, with insurer help lines second. Yet a major limitation of these sources, beyond the narrow dataset, is that patients typically access them after the prescription has been written, which makes therapy change decisions more time-consuming and can delay care.

Applying the pharmacist model

Among the 12 sources included in the survey, pharmacists were the only one to place in the top three on every topic, ranking second or third on cost, safety, and adherence. Respondents were nearly as willing to act on that trust, with 83% saying they would accept a pharmacist’s recommendation without seeking a second opinion.

Trusting pharmacists' input on medication costs is logical, given their unique role at the point where medication cost becomes tangible for patients. The cost conversation happens at the counter, whether anyone planned for it or not, and most patients still trust the pharmacist afterward. Clinicians who worry that discussing money will damage the relationship may find little support for that concern in the pharmacy, where the two coexist routinely.

If financial conversations moved upstream, pharmacists, who face ever-growing clinical, operational, and managerial workloads, would likely need to spend less time on price checks and callbacks, since many questions and concerns would have been resolved at the earlier visit.

Closing the gap at prescribing

To foster more cost conversations earlier in the prescription journey, prescribers would benefit from access to the same pricing information pharmacists see at the counter.

As our survey results showed, viewing only a single price may not be enough to establish trust in a pricing source, given that discount card websites ranked sixth on cost, below insurer sites, insurer help lines, pharmacists, prescribers, and drug manufacturers. A patient shown only one price has little to weigh it against, while a prescriber who can compare covered, discount, and cash options offers more to the patient at a critical moment in their care.

Electronic health record developers, health plans, manufacturers, and discount programs could support these early prescribing decisions by enabling providers and patients to view more pricing options at the point of prescribing. In that moment, the patient can weigh treatment options, pharmacy, and price, unlike when the prescription reaches the pharmacy counter, and choices are often limited to two: pay or walk away.

Joseph Kleiman is president of Buzz Health.