Managing Medicine Wisely

It seems obvious that taking medicines that have been prescribed by your physician is important to controlling illness and curing disease. However, in the review of a large number of studies looking at how compliant patients were in taking their medications, Dr. M. DeMatteo (Medical Care, Volume 42, 2004) found that an average of 25% of patients were not taking their medications as prescribed (I talked about this from a different perspective in another column “Are You Taking Your Medicines?”) In a study recently published, Dr. M. Kirk and Dr. C. Hudis (Clinical Breast Cancer, Volume 8, page 155, 2008) found that 20% of women were not taking their breast cancer hormonal therapy due to the expense of drugs.

All patients have recognized how expensive brand name medications are becoming, so it is important for us to look at ways in which we all can manage our medicines wisely so that we can be as compliant as possible in taking the medications that we need, increasing our length of life, decreasing our mortality from heart disease, diabetes, and other chronic illnesses. And we can save enough money to have a lot more fun in our spare time!

There are several components to managing our medications wisely. The first and most important is to have a personal commitment to taking the medications that are important to our medical care, trying to minimize side effects and trying to minimize the costs of those medications so there are as few pressures as possible that would cause us to try to skip doses of medicine.

The second factor is really important: Ask your physician to help to select the most affordable medications. First, you should ask your doctor to check to see if the medication he is considering prescribing is covered by your personal health plan. Many brand name drugs have a lot of hoops to jump through before plans will cover them. Ask the physician if there is a generic substitution that could be tried first, providing that it is as effective.

If the physician really has to use a brand name drug rather than a generic (always know that generic drugs are much less expensive than brand names), ask your doctors if they have samples. Most offices have samples of drugs that are being prescribed and can make those available to patients to reduce the costs of medication.

Most patients do not know that manufacturers are trying to help patients with limited resources or small incomes by providing free medications for such individuals. Ask your physician if you can contact the manufacturer for a patient assistance program. Almost every manufacturer has these available. Don’t forget to let the company know if you have special expensive circumstances, such as caring for a relative or paying for your kids tuition, since the companies are trying to be compassionate! Also ask the physician if there are any rebates or coupons for free initial prescriptions that you could use to reduce your cost of care.

Another important consideration is whether the brand name pills which are being prescribed are able to be safely split. Many pills can be prescribed by the physician at twice the dose and then split by the patient at home using an inexpensive pill cutter. In most cases, this reduces the cost of medications by 30 to 40%.

If the physician feels that a generic may be used, carefully shop at your pharmacies to determine if there is a very low cost generic prescription plan available. Almost all pharmacies now have such programs which reduce the cost of a prescription down to $3.00 to $5.00 per month for most generic drugs.

Lastly, there is a very important consideration in managing your medicine if you have a prescription plan which has a maximum coverage, or a coverage that slips you into a “donut hole” after an initial period of high coverage (this is nearly universal with Medicare Part D prescription drug plans). If your drug plan does have a limitation on coverage, consider purchasing generics at a pharmacy for cash, and not asking your health plan to pay for the inexpensive generics. The reason for this is that many health plans (and all Medicare Part D plans) charge generic drugs at full retail price which may be $100.00 to $300.00 per month, and use up the patient’s coverage limits. Obviously, brand name drugs are always charged at nearly a full retail price. If a patient uses the prescription drug coverage to pay for brand name drugs and not generics, the patient may use up the limits of coverage more slowly.

Let me give you an example. Consider a patient who has a health plan which limits his annual coverage for drugs to $2,000.00. (In Medicare Part D, this might be the initial coverage limit before the patient slips into a “donut hole” where they have to pay for all drugs themselves). If a patient who has a prescription drug plan with limited coverage of $2,000.00 is taking three drugs, two generics and one brand name drug, the following details show why purchasing generics drugs outside of the prescription drug plan may make sense for that person. In this example, the patient’s first generic drug costs the patient only $3.00 per month, the plan is charged at the retail for that drug at $185.00 per month. The patient has a second generic drug which again may cost only $3.00 per month, but the plan is charged at a retail of $155.00 per month. A third prescription has no generic equivalent, and the patient must use the brand name drug. This costs $225.00 per month and the plan pays for that as well. If the plan limits total coverage to $2,000.00 per year, the patient who uses the plan to cover all three drugs uses up his prescription drug coverage in 3-1/2 months and then has to pay the remainder of the year at 8-1/2 months of his prescription pills, or $1,963.00. If the patient pays $6.00 per month for the generics outside of his drug plan, and uses the plan only to pay for the brand name drug, the plan coverage lasts 9 months and the patient’s annual costs total only $747.00. By using his health plan to pay only for brand name drugs, that typical patient had a savings of $1,216.00 or 62% of the total drug cost. So for that example, choosing to purchase generics outside of a prescription drug plan that has a limit makes sense for most people. If you have a prescription drug plan with a limited coverage, review the details of your plan with the pharmacist or your insurance agent to see if this is right for you.

Taking prescription drugs which have been prescribed to control a serious illness is an important consideration. Always try to find a method to make certain you can take the drugs that your doctor wants you to take, and if you are having trouble please contact the doctor.