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A 45-year-old woman with type 2 diabetes was showing some control of her hemoglobin A1c under the supervision of Virag Y. Shah, MD, but not as much as the Whittier, Calif., family physician would have liked. He decided to add pioglitazone, a thiazolidinedione marketed as Actos, to the patient's armamentarium. The woman's blood sugar levels did not drop after three months, so he upped the dosage. Another three months passed, and still nothing. To the contrary, the woman's glucose levels rose slightly.
"Are you taking the medication?" Dr. Shah remembers asking his patient.
"Not all the time," the woman sheepishly answered.
"How often are you taking it?" he asked. "Once a week? Every other day?"
"Well, less than that," she said.
"You're not really taking it at all," Dr. Shah said.
"Well, that's right," the woman answered.
"Did you fill the prescription?"
"No," she said. "It was going to be $180 a month because it wasn't covered. And I can't afford that."