As family doctors, we hear every day from patients who have trouble paying for medications and who have stopped or skipped their drugs. Last month we sent a woman to the hospital because she hadn’t taken her diabetes medication ("too expensive") and she ended up with a bad infection in her leg when her blood sugar went too high. Sometimes families pool their money to help someone buy the drugs they need.

I’ve spent eight years in Hawaii trying to find ways to make medications more affordable. Here’s what I’ve learned from my patients and other doctors:

» Talk to your doctor. Tell him or her that you need help with the cost of your prescriptions. Some people are embarrassed to ask. We surveyed nearly 250 Hawaii physicians, and 98 percent said that being aware of drug costs for patients was very important to them. Other studies find that two in three people who stopped their medications because of cost never told their doctor in advance, even though it could harm their health.

Sometimes there are several drugs that work in the same way, but your drug insurance might cover only one or two of them. Ask your doctor to review your current medications to see whether any can be replaced with less expensive drugs. If you’re paying $25 or more each month for any drug, it’s a good idea to ask your doctor to check whether there’s a less expensive drug, covered by insurance, they would be comfortable prescribing. (Recently a neighbor told me she was paying $50 per month for a heartburn drug when a $5 version probably would have worked OK, too. That’s a difference of $45 per month or $540 per year.) The most expensive drug isn’t always the best.

» Shop around. If your drug is not covered by insurance, then you should know that like anything else you buy, different stores charge different prices. Call different pharmacies and ask how much the prescription will cost, and keep in mind that certain pharmacies (such as www.walmart.com) offer a list of drugs at low cost ($4 per month for certain generic drugs). If your drug is covered by insurance, your co-payment should be the same at any pharmacy.

» Check out mail order. If it’s a pill that you take every day for chronic conditions like high blood pressure or diabetes, some plans offer a discount if you order three months at a time by mail. Make sure your drug is working well and that you won’t be changing the dosage.

» How doctors can help. We found that eight in 10 patients want doctors to talk about drug costs with them and to consider cost when choosing medications. Our study of 5,085 people with diabetes from 10 U.S. health plans found that one in three people want their doctor to tell them about less expensive drugs, even if these drugs might have a slightly higher chance of side effects or even might not work as well.

To help doctors to find drug cost information, we’ve put together a free website for Hawaii physicians — www.PrescribingGuide.com — to help save time. For the last two years, it’s included drug formulary information from five health plans in Hawaii for 11 common health conditions, such as asthma, hypertension and diabetes. It also lists retail prices and has direct links to formularies and patient assistance programs (www.rxassist.org).

Formularies change, so the website is updated monthly with the support of the University of Hawaii and the nonprofit Pacific Health Research and Education Institute.

Dr. Chien-Wen Tseng is a family physician and faculty member of at the Department of Family Medicine and Community Health at the University of Hawaii at Manoa’s John A. Burns School of Medicine. She is also a physician investigator for Pacific Health Research and Education Institute and VA Pacific Islands Health Care System.