Posts Tagged medications

Generic Medications — where to get them

genericpillGeneric medications are supposed to be inexpensive!  But, not if you are facing price gouging.  Your favorite chain pharmacy may rip your wallet out and empty it.

The PBS NewsHour reported on 12/23/13 an astounding survey   — they found a generic medication for breast cancer (letrozole) ranged in price from $9 to $400 dollars for a 30 day supply.  Even more surprising the company that charged $400 dollars agreed to match the $9 price at a competitor.

Not only do pharmacies price gouge so do insurance companies.  Almost uniformly insurance drug plans add $20 to every generic prescription.  So a typical $10 generic prescription without insurance involvement will cost you a copay of $30 with insurance.  And, do you think the pharmacist will suggest you avoid using insurance — not usually, since the $20 copay is for them!

What should you do?

  • Shop around — check prices at several pharmacies
  • ASK if there is any program the pharmacy has to lower that price (sometimes if you get a shoppers card you get better prices)
  • You don’t need a membership to get prescriptions from Costco.  Consumer Reports rated them as having the best generic prices.
  • Here is a great place to check prices:  goodrx.com  (and they will print coupons for free!)
  • You can get mail order generics here with free shipping.  Usually their prices are good:  healthwarehouse.com
  • Don’t involve your insurance plan if it costs you more out of pocket than just outright paying for the prescription.
  • Insurance plans often limit the prescription to 30 days (with a copay every time).  Getting your prescription in 90 day amounts saves trips to the pharmacy and often improves the discount.
  • Pharmaceutical companies often make a long-acting medication just before the patent runs out on the short-acting form.  Ask your doctor if the long-acting medication is absolutely needed.  Sometimes taking a medication twice a day at a generic price is much less expensive than once a day at a brand name price.

The price gouging is astounding.  Patients often think a pharmacy just adds a small amount to the wholesale price.  Not so.  They often set the price at some percentage less that the brand name — hugely more profitable for them and devastating for consumers.

The price gouging makes you understand better why the UK and other countries have legislated a solution — they negotiate a country-wide price for each generic medication and allow only a few dollars to be charged as a dispensing fee.  The US has a long way to go to protect consumers and reduce health care costs.

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Prescriptions — the missing manual

samplerx

The above prescription example comes from Medical School Headquarters intended as an example of what doctors should NOT do — that is to issue handwritten prescriptions.  There are just so many possibilities for error mostly coming from illegibility.  Also, errors from inadequate information provided to the pharmacist and the patient.

Electronic prescribing is unquestionably the best solution.  Patients should choose prescribers who use computer software to send prescriptions to the pharmacy.  In fact, prescribers who don’t use computers to do this are dinosaurs soon to be extinct — perhaps it would be a good time to leave that office practice and find something more modern.

You might think electronic prescribing solves all the problems, NOT SO.  Just ask any patient taking a few medications on a regular basis!  Here is what they say:

  • My office appointments never match when prescriptions expire –so I either have to change appointment times or hope the office will renew the prescription early — always involves a phone call and wastes my time.
  • I had no idea the doctor prescribed a brand name drug instead of a generic and I got hit with an unnecessary huge bill.
  • The doctor has no idea how much medications cost.
  • I need 90 day prescriptions for some things and 30 day prescriptions for other things but they can’t get it straight.
  • My doctor’s computer system can’t send things to my mail order pharmacy
  • I have to send prescriptions to my mail order pharmacy myself — usually they are the handwritten type and sometimes the pharmacy can’t read them.
  • If my doctor issues a duplicate prescription so it will last until my next visit sometimes I get more medication (and cost) than I need.
  • Often generic medications are less expensive if I purchase them without involving insurance — the pharmacist sure does not tell me that!

Here are some prescription suggestions for PATIENTS:

  • ALWAYS take a list of prescriptions with you to health care appointments (or just take the bottles, but there is a risk of loosing expensive medications in the process).
    • Your record should include the name of the medication (brand name if appropriate) and generic name
    • Dose — that means the size (mg) of the pills and number taken, or amount of liquid (ml) or strength (%) of a cream or ointment
    • How often taken and whether scheduled or as needed
    • Why the medication is taken
    • Number of doses of medication prescribed AND exactly how many days that covers (like 30 day supply)
    • When that medication will expire and need refill
    • The pharmacy phone number and FAX number (the latter is very important for mail order pharmacies)
  • ASK if a new medication is generic and if not if a suitable generic is available.  Or, if a suitable generic in the same drug family is available.
  • ASK if the medication is short term or long term.  If it is long term usually ask for 90 day supply with 3 refills (if insurance will approve).  And, use mail order services advised by the insurance company since they are usually less expensive.
  • BEFORE leaving the prescribers presence ask if the number of refills on a new prescription will last until next appointment?  And, ask for an extension of refills for older prescriptions that will expire before the next scheduled visit (otherwise you get the fun of calling the nurse for refills)
  • If a specialist prescribes a medication ASK if the specialist plans on long term follow-up and providing refills — if not what communication with primary care will convey the needed prescription information.  But, if the specialist plans on managing the medication expect a full review of all medications to avoid duplicate prescribing and adverse drug interactions.

Here are some prescription suggestions for PRESCRIBERS:

  • Consider the cost of medications — you can’t do that if you don’t find out how much they cost, especially the brand name drugs
  • Prescribe the lowest cost alternative.  Before prescribing a brand name drug ask if you are sure there is a real cost benefit over an older generic.  If you don’t know, find out.
  • Don’t prescribe antibiotics for viral infections
  • Think about refills, don’t just write some arbitrary number.  Make sure the patient has enough refills and will not have to call your nurse to get them.  Contrary to popular belief patients do not like to go the the pharmacy — give 90 day prescriptions where possible.
  • Have a patient Internet portal to deal with medication refill issues.
  • Although it’s nice to compute the number of pills a patient will need it is sometimes better for insurance reasons to say the number of days of medication is needed ( 7 days, 90 days etc.)
  • To avoid duplicate prescriptions when the patients prescription will not last until the next scheduled visit the following statement is helpful “extend existing active prescription so refills last until ____ “(e.g. a year from today).  Sometimes: “stop refills on current active prescription.  This is a replacement so note the changes.”
  • Most mail-order pharmacies will take either electronic prescriptions or faxed prescriptions — it is not rocket science to get those numbers into the electronic prescribing system — make it happen.

Finally, sloppy prescribing causes patient injuries, provider law suits, extra time, and extra costs for both the patient and the prescriber.  Electronic prescriptions are a step in the right direction but they are now mostly geared for pharmacists and not the real-world problems of patients.  The integration of pharmacies within care delivery systems (e.g. an ACO) is an urgent need.

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Hospital Readmission — some help

2 fingers

Here are two simple things hospitals could do to reduce readmissions:  1)  Make a primary care appointment for hospital follow-up at the time of discharge  2) Dispense enough of the patient’s medications to last until the primary care appointment or to last 2 weeks, whichever is longer.

Patients are often readmitted because they did not take the medications prescribed at discharge.  The beauty of the suggestions:  hospitals save money since the cost of medications is low by comparison to readmission, patients will likely take the medications they are given, primary care providers will be engaged, and there is a financial incentive to make the appointment within 2 weeks.

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