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In reply

We appreciate the comments of Sherrick. We agree that medication decision making is complex and that shared decision making with patients is an essential aspect of good patient care. However, research on medical decision making suggests that the majority of physicians (65% in one study¹) do not discuss medication expenses with patients. Furthermore, if financial considerations from the patient perspective alone were the primary factor determining biologic drug prescription decisions, one might expect that the proportion of patients with public insurance who received prescriptions for etanercept would be smaller than the 26% observed in our sample.

Among the models that attempt to explain whether and how physicians factor their patients' insurance plans into prescribing decisions, the modal insurance model is one of the strongest.² In this model, the extent to which physicians' prescribing decisions are influenced by medical insurance coverage is based on the modal—or most frequently . . . [Full Text of this Article]

AUTHOR INFORMATION
Esi Morgan DeWitt, MD, MSCE; Henry A. Glick, PhD; Daniel A. Albert, MD; Frederick Wolfe, MD