Posted tagged ‘medications’

Preventing prescription pitfalls – How to save money and hassle at the pharmacy

September 17, 2018

The Pediatric Insider

© 2018 Roy Benaroch, MD

Doc writes prescription, pharmacist fills prescription, insurance covers prescription. Simple, right? But that’s not the way it works anymore.

Some changes are good. Gone are the cryptic abbreviations and illegible handwriting–replaced by computer printed scripts, or better yet scripts magically transmitted via the ether. But along with fewer errors there’s even less transparency on pricing and coverage. Patients, who haven’t been to pharmacy school and couldn’t possibly decode the pages of exclusions and conditions in their insurance contract, get hosed. And doctors and pharmacists get blamed.

Remember this, if nothing else: it’s all gamed by the payer. Insurance company tricks are there to prevent them from spending money on your health care, while making your doctor and pharmacist look bad. Inscos are often abetted by Pharmacy Benefit Managers (PBMs) – middlemen who skim even more health care dollars off the top, adding another layer of screwage.

But you can fight back. Here are some tips to help you get the medications you need, affordably.

Ask for generics (from your doc and pharmacist). There are often generics available, though these days they’re not always cheaper than the brands. Ask anyway. Remember that newer, brand-only drugs are not more likely to be better or safer. Go with an older, established medication if you can.

Don’t assume your “insurance price” is the best price. You might think your insurance-negotiated rate is better than what you can get without insurance. That’s not necessarily so. Those PBMs mark up everything, and often drive the price of very inexpensive drugs higher for those with insurance. Ask for the retail price to compare. And check out pricing sites, too.

Visit NeedyMeds.org for drug-discount programs and other information. This is a great non-profit, non-commercial site that pulls together just about all of the information you need to save money on prescriptions. There’s a price look-up, lists of industry- and private-sponsored assistance programs, and tons more.

Try out other “pricing sites” to help compare. Two simple ones that work well are Goodrx.com and WellRx.com. They don’t have the depth of info that NeedyMeds offers, but they’re simple to use to find prices in your area. You’ll enter the name of your medication and your zip code, and get back the price (to the penny) available at local chains. This assumes you don’t use your insurance – so keep in mind buying meds this way won’t count against your deductible.

Look into “90 day” supplies of medications. If you’re on a stable dose, your doc may be happy to write for 90 days instead of 30. That often saves $$. But you won’t be able to refill your next supply until that 90 days is almost up, so pay attention to the calendar. If your doc sends the prescription in too soon, the pharmacist will hold it until your insco deems it time for you to be able to refill it. Not doc’s fault, not pharmacist’s fault.

Don’t assume mail-order pharmacies are cheaper than filling locally. This happened to me – the Aetna mail order 90 day supply price was twice what it cost to fill the same medication for 90 days at my local pharmacy. Unexpected. But I’ll take the less-expensive, less-hassle option of a local pharmacy for sure.

Not-in-stock doesn’t mean never-in-stock. If your medication is out of stock at your favorite pharmacy, they can usually order it in just a few days – just ask them, if you’re not in a huge hurry to get the meds. If you are in a hurry, call around to different chains (not just different locations of the same chain, which probably use the same warehouse to resupply them shelves.)

Avoid “prior authorization” medications when possible. A prior auth is a nightmare, designed to prevent you from getting medicine while making it look like your doctor’s fault. “Just tell them to do a prior auth,” you’ll be told – but doing a prior auth typically takes a tremendous amount of time and frustration, and unless you’ve met the “secret criteria” it’s not going to work.

If you do need a prior auth, figure out the “secret rules” first. As with any game, you won’t win if you don’t know the rules. If your insurance insists on a prior authorization, call them and get them to tell you exactly what is needed to happen for the prior auth to be approved. Do you need to try one or more medications first? Which medications? What are the criteria that they use to make their determination of coverage? If you can find that out and tell your doctor, it will save everyone a lot of hassle – and you might just get your meds covered.

Consider OTCs over prescriptions. There’s a mystique to prescription medications, and that makes it seem like they’re more powerful or more-likely to work. That’s just not true. For conditions like allergies and acne, OTC meds or combinations of OTCs and prescriptions are often just as effective, safer, and cheaper than prescriptions.

The deck may seem stacked against you – the insurance company has the resources, and they make the rules. But you’ve got your doctors, nurses, and pharmacists on your side. Work together to get the meds you need at a price you can afford.

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Many medications are safe for nursing moms

February 22, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

An exhaustive new review should provide reassurance for nursing moms: many medications are safe for you to take, and genuinely serious reactions are very rare. Moreover, most serious reactions that do occur are to just a handful of medications. Common sense can be a good guide to keeping nursing babies safe when their moms take medication.

In this study, from February 2016, the authors did a truly comprehensive search of the literature for all studies and case reports of problems caused by medications in breast milk. The same authors had done a similar study in 2002, and decided it was time for an update.

Some of the findings:

  • About 60% of reported reactions occurred during the first month of life; and 80% during the first two months. This makes sense—the youngest babies consume the most milk per weight, and also have the least ability to metabolize medications.
  • 70% of adverse reactions were to medications that affect the brain, including narcotic pain medicines, antidepressants, and antipsychotic medications.
  • All of the deaths reported (there were only 2) involved one or more narcotic pain medications.
  • The use of multiple nervous system depressants at the same time increased the risk of serious reactions.

The bottom line: be careful especially with the youngest babies, especially when using multiple medicines, and especially when using medicines like narcotics that are known to cause slow and shallow breathing. That doesn’t mean nursing moms can’t take these medicine, but it does mean that they ought to take advantage of non-narcotic pain medicines, first, and if they do take narcotics their babies need to be monitored closely. A “pump and dump” strategy can be employed if mom needs potent pain medicines for a short time. It is not reasonable to expect nursing moms to live with untreated pain.

A great resource for nursing moms and the doctors who give them advice is the Lactmed database from the National Institutes of Health. You can look up just about any medication there, and see what studies are available to give you real and reliable information on milk transfer and potential issues with nursing babies. Some of the information is quite technical, but it’s better than the vague handwaving found in other places.

Speaking of which: one of the worst places to look for safety info for breastfeeding moms are the official “product inserts” of medications. They pretty much always say that nursing moms can never take any medicine (I don’t think they’re allowed to eat any food, either. Just water and rocks. Safety first!) Remember: product inserts are written by lawyers, for lawyers. They’re there to fulfill the crazy byzantine regulatory framework of the FDA. And to ward off lawsuits, and possibly vampires too. They’re not there to give parents or doctors useful information.

The health of moms is important, too. Often, moms stop taking their own medications out of fear that it may harm their nursing baby. Reviews like this, looking at what’s actually published and documented, provide some useful reassurance for moms and babies alike.

Wet nurse

Drug expiration dates: Do they really matter?

July 24, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Mernga wanted to know about drug expiration dates. Do drugs really “go bad”? Or this is just a scam to get people to buy fresh medicine?

The truth is, they’re a little of both.

There are sometimes two separate “expiration dates” on a prescription medication. The first is the one stamped on the package by the manufacturer. You’ll see that one if what you have is in the original packaging, like a tube of ointment or a small bottle of eye drops, or a bottle of pills if you’ve been given an original bottle straight off the shelf.  Sometimes the manufacturer’s stamp is on a box that the tube or bottle came in (the one you’ve already thrown away.)

exp date on package 1

 

exp date on package 2

The manufacturer’s stamped expiration date is a promise that the medication will keep its potency at least until that date, if it’s been stored correctly. It doesn’t mean that on that date it will actually go bad, but the manufacturer is saying, look, if you use this stuff past the date, we’re not responsible for it any more.

It turns out that many medications will keep at least most of their potency for a while after that date. The best studies that are looking into this are sponsored by the US government through “SLEP”—the Department of Defense Shelf Life Extension Program. This program tests the potency of medications that are kept in long-term strategic stockpiles for the government. It turns out that the feds are keeping big stores of anibiotics, morphine, antihistamines, and many other essential medications for use after The Zombie Apocalypse. To save money, they keep the medicines well-past their expiration dates, while testing selected lots for potency. On average, medications in the program are lasting 5-6 years past their dates—some lasting 15 years or more.

However, the drugs in this program are stored until optimal conditions, in a cool, dark, low humidity facility. They’re all in their original packaging, too. Drugs really can be sensitive to storage, and can rapidly lose their punch if exposed to heat or light, or if they’re moved from bottle to bottle, or removed from foil seals. Also, there’s a lot of variability in the shelf-life of medications, even between lots of the same medication. So though we know that most drugs will last past their dates, it’s hard to know specifically what medications on your shelf will last just a few months longer, or several years longer.

The form of the medication does seem to be important. Hard, dry pills last longer than creams or ointments or liquid drops. Reconstituted suspensions (where the pharmacist adds water and mixes it at their store) last the shortest, and are the most vulnerable to heat and storage conditions.

Though the main issue with older, expired drugs is potency—some get weaker with time—there’s been some concern that at least some medications actually become toxic when they’re old and past their prime. The classic example of this is an older formulation of tetracycline, which was reported in the 1960’s to become toxic to the kidneys if used well past its expiration date. That form of tetracycline is no longer sold in the USA, and it’s not really clear to me if that reaction was ever substantiated. I don’t think there’s much risk of old medicines becoming harmful—it’s more that they might not work as well or as reliably.

There’s a second date that will appear on any prescribed medication, a date typed on by the pharmacist that is usually 12 months after the prescription was filled. This date is added to discourage hoarding of medicines—after all, it may be unlikely that something prescribed a year ago is still needed. It also may be true that my moving pills from the original container (a big bottle) to the new container (a little bottle) they’ll lose some of the manufacturer’s guaranteed protection against aging. Though I don’t want anyone to hoard medicines, especially antibiotics and narcotics, depending on what the medicine is used for it sometimes makes sense to keep a medicine past the pharmacist’s date for occasional use. When in doubt, ask your doctor.

exp date on bottle

The bottom line: these dates are a guide, but for non-critical medications, especially if you’ve been good about storage, it’s probably fine to keep using them past their prime. If the medication is critical, I’d go ahead and keep an eye especially on the stamped manufacturer’s date. Stay safe, and keep important medicines fresh.

The best drug discount card

May 2, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

I’ve gotten loads of drug discount cards in the mail to give out to patients. They look almost too good to be true—they claim to have no costs, and to provide discounts on prescriptions of up to 75%! Wowza, can’t go wrong with that! Right?

When something looks too good to be true, it usually is.

I’ve gotten these from a few different organizations, but they look similar. One is from “The Healthcare Alliance”, which has a .org web address on their letterhead—that extension is traditionally used by non-profits, but when you look through their website, they don’t claim to be non-profit. And in fact the .org address actually forwards to a .com site.

I found an exposé of their pharmacy discount card from a local TV investigation. The good news is that it does work, at least some. The amount of discount varies widely. On average, their reporter got a 23% discount off retail prices. But the card doesn’t really help people with insurance—it won’t cut your copay, and insurance drug costs are already negotiated downwards. The biggest savings seem to be for people without insurance, and only for some of the most popular generics.

The bad news: companies like this collect your personal information, including your contact info and information about the medicine you purchase. They sell this info to marketers who will use it to try to sell you more stuff. Now, you may not mind this, but you ought to at least think twice before agreeing that all of this personal health info is being sold. Marketers will know if you have diabetes, or hemorrhoids, or if you’re on a birth control pill, or if you’ve taken morning-after contraception, or if you’re on medicine for anxiety or depression or genital warts. To me, that’s kind of creepy.

The good news is: there is a better way! A retired-doctor-friend of mine, Rich Sagall, has set up a real non-profit organization that offers comprehensive, reliable information on saving money on prescriptions—and his site has a downloadable drug discount card too. Best of all, the Needymeds privacy policy is right there for you to see, and they do not, ever, sell or use your private health information for marketing. They promise to keep your health info private, the way it should be.

So: forget about those too-good-to-be-true discount cards from for-profit companies. You can save money by using generics and by taking advantage of the Needymeds non-profit, 100% legit discount card. That one is NOT too good to be true. I guarantee!

Can doctors be bought?

October 5, 2008

As recently published in The New York Times, Dr. Charles Nemeroff from Emory University has been accepting millions of dollars of income from pharmaceutical companies and device manufacturers without accurate disclosure. In other words, he’s taking money from the companies whose products he is endorsing and supporting through published articles, speaking engagements, and research. Lots of money, and he’s been doing it for years.

Dr. Nemeroff is no ordinary psychiatrist. He’s published hundreds of papers, and has served on dozens of corporate boards. Until recently, he was the editor of the very influential journal Neuropsychopharmacology—and is said to have been driven from this position after an outcry over a positive editorial over a medical device made by a company with which Dr. Nemeroff had financial ties. Again, no disclosure was made of this at the time.

This case is far from isolated. Earlier this year it was widely reported that Dr. Joseph Biederman of Harvard University was caught in a similar scandal. He was recommending and endorsing an ever-increasing use of certain medications while taking millions of dollars from their manufacturers. In this case, Dr. Biederman was most closely associated with a trend towards diagnosing and treating bipolar illness in children with powerful antipsychotic drugs that had never been approved for this use by the FDA. (more…)