Posts Tagged prescription

Prescription Refill — a snarl of patient frustration

Patients dearly hate the hassle of requesting refills on medication prescriptions. Why?

  • The prescriber’s office takes days or weeks to respond (low priority).
  • The prescriber’s office requires an office visit, but can’t make an appointment until next month.
  • The patient fears running out of needed medication for asthma or migraine headaches or diarrhea.
  • The prescription has expired or did not have the expected refills.
  • A new insurance plan started
  • The insurance plan calculated the patient still had a day left on the previous refill and says to wait. (patient has something to do tomorrow besides rush to the pharmacy).
  • The person who answers the phone at the prescriber’s office can’t refill low-risk medications. So, a message is left for the physician who is out of the office and back-up physicians don’t do refills.
  • The prescriber’s office says to call the pharmacy while the pharmacy says to call the prescriber’s office.
  • The unnecessary visit to the ER just to get a refill.

It’s so easy for prescriptions to become “out of sync” with prescriber office visits. A cancelled appointment, a doctor’s vacation, a visit for an inter-current illness (a walk-in visit), an “as needed” medication that the prescriber forgot to re-prescribe at the last office visit etc. etc.

The pharmacy is also to blame by ridiculously refusing refills within a few days of running out of medication. And, waiting until the patient shows up at the window to say, “looks like the med is out of stock.”

It’s amazing more patients don’t require a mental health visit after trying to get refills.

According to a 2012 study only a third of primary care practices had a formal renewal policy. The big advantage for patients is quick turn-around for non-hazardous medications (like thyroid or asthma meds). Within the practice the amount of “churn” was less (fewer internal messages and delays). Plus, with a formal policy 100% of the patient charts were checked to verify the medication, allergies, last appointment etc. Another article actually listed medications safe for refill.

Solutions:

  • Give your prescriber a copy of the 2012 study
  • When ever you receive a prescription ask “how many refills and how often?” And, ask for 90 day supplies to minimize refills.
  • Keep a list of when each prescription will run out. Check it frequently and call the prescriber two weeks before the med is needed.
  • Ask your pharmacist if they have “grace” days which allow refills within a week of prescription expiration (use those pharmacies)
  • Know the difference between a refill (an existing prescription with active refills) and a renewal (a new prescription for the same medication)
  • Respect the guideline for prescribers to see patients at least once a year when a patient is taking medications. Keep up to date.
  • When a medication is taken “as needed” or PRN don’t hesitate to make an office visit to clarify when to stop taking or when to change the dose.
  • If a pharmacy is out of stock of a medication ask the pharmacy to transfer the prescription to another one that has the medication.
  • Always call the pharmacy before picking up a new medication to make sure they have it and that insurance will pay for it.
  • When you pick up medications don’t walk away from the pharmacy counter without looking at the medication and label to make sure it’s the right prescription (not some old one with the wrong dose). Pharmacies will not take medications back if you leave the store.
  • If you are notified your prescriber is leaving, check you prescriptions and call the office if you will run out of medications in a few months. Immediately make an appointment with someone new and have copies of your records transferred. Sometimes new appointments must wait for several months.
  • Your prescriber is responsible to maintain and monitor prescriptions — NOT the pharmacist and NOT the insurance company. If the prescriber’s office is not up to the task dump them and give them bad marks on Healthgrades.

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Prescription Medications — sky high price

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Elisabeth Rosenthal wrote the lead story for The New York Times today (10/13/13) “The Soaring Cost of a Simple Breath“.  This is another blockbuster exposé of drug costs that are crippling US health care.  Sadly, not a story about what is being done to correct the problem.

Here are some of her key points:

  • The average brand name prescription has risen from 1995 at $40 to 2013 at $170
  • The average generic prescription has risen from 1995 at $20 to 2013 at $45.
  • A common asthma medication Pulmicort costs $175 in the US but only $20 in the UK and $25 in France.
  • Drugs account for 10% of the $2.7 trillion annual health bill.
  • Americans take more generic medications than people in other countries (they just can’t afford branded or new medications)
  • Other countries set the wholesale price of drugs to make drugs affordable.
  • US pharmaceutical companies have used the FDA to restrict manufacturing rules to favor large companies and have used the judicial system to bankrupt competitors.
  • US pharmaceutical companies have paid generic companies not to sell their products in the US.
  • Medicaid, paid for by taxes, pays millions of dollars to drug companies for high priced medications.
  • Asthma medications have been the target of profiteering drug companies.  Not a single inhaler is available as a generic.  Despite the fact that inhaled medications have been available for over 30 years.  The effect on people with this condition is a tremendous burden.
  • Drug companies spend about 50% of funds on marketing and only about 20% on drug research.  Other advanced countries prohibit marketing prescription medications directly  to consumers.
  • Medicare is prohibited from negotiating prices.
  • Drug prescribing guidelines published by the government are prohibited from considering cost.

Rather than just be angry about the sorry state of drug costs, what can be done?  Just take a lesson from other countries, this is not rocket science:

  • The US government should set the prices for all drugs
  • The FDA needs to loosen the rules for generic manufacturing — for goodness sake, an inhaler is an inhaler, not the space shuttle.
  • Comparative effectiveness research should be required, and the results published for doctors as in the UK.  Drug cost is important to all US citizens, so restricting the government from considering cost  borders on insanity (perhaps giving psychiatric medications to Congress is currently too expensive).
  • Finally, there is no excuse for the current drug cost problem — other countries have solved the problem, the US needs to do the same.

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