Displaying medication costs on dispensing labels as a strategy to reduce wastage: views of the Welsh general public.

Introduction: In 2015, the UK health secretary made public an intention to include the value of medicines costing over £20 on dispensing labels as an attempt to reduce wastage attributable to patient behavior. However, there is a lack of evidence investigating the potential effect or feasibility of this proposal, and concerns have been raised that it may introduce new problems in vulnerable groups. This pilot study aimed to gather views of the Welsh general public on this subject.

Methods: Six focus groups from within key population groups were conducted. A snowball sampling strategy was employed with participants recruited via a neutral gatekeeper. Focus groups session were audio recorded and transcribed verbatim and iterative thematic analysis was used to identify emergent themes.

Results: Six focus groups were conducted. Three key themes were identified: "influence of cost" - whereby participants expressed concern about cost linking to their perceived value, guilt for needing prescribed medication and irrelevance of cost if the medication was considered necessary; "knowledge is power" - whereby participants expressed a desire to know more about their medicines and engage with health care professionals about them, and felt information on dispensing labels alone would be insufficient to support this and "blame the system" - whereby participants felt responsibility for wastage should be shared by both system and patient and identified existing wasteful practices such as inappropriate prescribing, ordering and disposal of returned medicines.

Conclusion: Findings were largely consistent with criticisms publicized by professional bodies that introducing cost may serve to make patients feel guilty or unworthy rather than encourage them to use their medicines appropriately. Similarly, providing cost information on labels alone was considered insufficient and therefore additional counseling or education would be necessary to prevent misunderstanding. The acknowledgment of system factors contributing to wastage highlights an important role for pharmacists to become involved in using medicines more cost-effectively. However, cost was considered irrelevant if the medicine was deemed necessary by the patient, and therefore more mindful prescribing of superfluous items should be promoted.