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BY TOM BRAUN, Registered Pharmacist

The task of reducing prescription costs without jeopardizing the quality of medical care requires the patient or their caregiver to understand exactly what can be changed in the prescription prescribing program for the benefit of the patient. A proactive approach to achieving a less costly prescription program requires developing a dialog and a cooperative attitude from the prescribing physician.

In many cases, the physician ignores the cost side of the prescription product because he knows most patients don't pay for the drugs out of pocket. This situation is dramatically changing in the last six months of 2006. Almost 7 million seniors will be paying out of pocket at full retail for their prescription drugs for the some portion of 2006.

Here are some questions that the physician should answer.

  1. Is the dose appropriate for my weight? In most cases, a 110 pound woman should not be prescribed the same dose of a drug as a 220 pound man. It can work both ways. It can be an overdose for the woman or an under dose for the man.

  2. If the physician assures you the dose is correct, then the next question should be: Are you prescribing the drug as a generic or a Name Brand product? The obvious answer is that in most cases the generic should be prescribed to reduce the cost of the prescription.

  3. Now for the hard part. Can you prescribe a double strength of the drug so I can split it and save money? In most cases, the physician will not know this unless he looks the drug up in his Physicians Desk Reference and looks at the actual picture of the drug. If the drug is not scored, it is doubtful if it would be worthwhile to split. Some drugs are fragile in composition and will fragment easily. Others are enteric coated and can't be split. If it is a capsule you are just out of luck.

  4. If all the above fails, the following question should be asked. Can you prescribe a comparable drug that can be split?

You should also challenge your physician on why you are taking each medication he has prescribed. As an example, Allopurinol is for the treatment of gout. If your blood work is normal, and if you have not had an attack in years, it makes little sense to continue to be on the drug. Just monitoring your blood work in the future may be all that it takes to stay off the drug. Over utilization of drugs is a major problem that is seldom addressed by the physician unless he is challenged. Time pressure quite often prevents the physician from analyzing the drug regimen. Consulting pharmacists can be of help in this matter.

In addition, most of the newer prescription drugs marketed in the last ten years are of a me-too nature and are no more effective than tried and true generics that have been around for years. The only difference is they may cost 4 to 10 times as much as the older drug. Just switching to a proven older generic can save you a bundle

Sometimes, the appropriate dose is not available. As an example, a generic called hydrochlorothiazide (HCTZ) is not available in a 12.5 mg strength tablet. A capsule of this strength is available from Mylan at a much higher cost per dose than if you were to split a 25 mg. HCTZ tablet. The choice is obvious. Split the 25 mg tablet.
A website called "Institute for Safe Medication Practices has highlighted some of the challenges patients have regarding their prescription drugs. Go to www.ismp.org to learn more.

Here are some things they have learned.

  • Different tablet strengths often cost about the same. Patients who cannot afford their medications have received a higher strength tablet with directions to take ∏ tablet (or even π tablet) per dose.

  • Some health insurers have denied payment of prescriptions for the lower strength of certain drugs, thus requiring patients to receive the higher strength tablet and split it in half for each dose.

  • Some healthcare organizations have not purchased all commercially available strengths of oral medications. Thus, some of the drugs may require tablet splitting for patient-specific doses in the inpatient setting.

  • Patients may not be able to swallow whole tablets.

The key to controlling and reducing your cost of prescription medication is difficult, but can be accomplished with the cooperation of your physician and pharmacist. I believe overall, both professionals in most cases will show compassion towards the patient. If the physicians of this country would speak in unison demanding we fix our healthcare problems, then real true compassion would be demonstrated.

You can write Tom at tbran10@hotmail.com

Retired but not senile yet!

Copyright © 2006 Thomas Braun