Table 1 Examples of questions from the focus group discussion guide

First I want to ask how frequently patients with chronic disease bring up issues around affordability with you. Does this happen often? Sometimes? Never? Remember, these conversations can be as simple as a patient expressing concern about the costs of a medication, which isn’t covered by insurance. What is the culture around having these conversations in your practice or the delivery system in which you work?

When a patient talks about their out-of-pocket expenses related to their chronic illness, what topics do they bring up? How confident are you in answering these questions?

How important do you think it is to have a conversation about out-of-pocket expenses with your patients? [Probe: If it helps, you could think of it relative to other tasks you have to perform.]. If you don’t think it’s very important, who should patients have these conversations with?

What barriers get in the way of you speaking with your chronically ill patients about out of pocket costs?

From your observations, how are patients’ cost concerns impacting their ability to manage their health?