Saturday, August 25, 2012

Those Terrible Drug Compaines and What You Can Do to Save Money on Medications

It is easy to become enraged about cost of medicines in the US ; especially when you can get the same medication in other countries for a fraction of the amount.   Recently I prescribed a medication commonly advertised on TV.  Thirty pills cost over $700.  "This is outrageous", I agreed with the patient. Can they really expect people to pay this much!  Well before we light up the torches, grab our ropes, pitch forks, and gather all towns-people to hunt down this monster, lets think about this and extrapolate the consequences.  Here's another drug story.

There is a drug called cochicine for gout that has been around for a million years.  You could buy a fist full for less than a dollar. Then something strange happened.  Suddenly, this generic drug became unavailable. It turns out the company making this generic drug could not thrive because of the low profit margin.    In both cases, medication was essentially unavailable for opposite reasons.

Pharmaceutical companies will charge what the market will bear.  If the regional consumer, insurance company and employer will pay, then the drug company will charge. Undoubtedly, these companies have been gluttonous . Budgets and profit margins need to be trimmed so savings can be passed on to the consumer. But lets not throw the baby out with the bath water.  Profit motive has led to discovery of wonderful life saving drugs.  The quality of our lives are much better because of medicines like antibiotics, cardiac drugs, cancer drugs etc..  I do believe government has a role to assist in the development if "orphan" drugs, vaccines, and to ensure our safety. But to have government take over as some have suggested would be counter productive.  (You have to also ask what government and what companies since many are international )

There are things individuals can do to save money on medications:
  • Don't be afraid to ask for samples at the doctors office.  We are happy to give them away when available. 
  • The trend now is coupons.  Some will reduce the cost of the drug to generic level.  Go to the company website for more information. 
  • Pharmacies have special pricing so shop around.  Some pharmacies offer free antibiotics and diabetic medications. 
  • Call your insurance company to find out if there are equivalent medications that would provide savings and ask your doctor at the tome of your next visit if substitution is advisable. 
  • And finally if you cannot afford medication, most drug companies will give them to you for free.  You will have to provide them with some type of financial disclosure. 
  • One more thing.  Stay healthy.  Sounds obvious but I can't tell how many people on inhalers still smoke, hypertensives who overuse salt and diabetics who frequent all you can eat buffets. Most people can reduce the number of medications taken  by using a little common sense.

Sunday, July 29, 2012

"So What Do You Think About Obamacare?"

....Is the question I am asked all the time....usually as we are walking out of the exam room after the visit. The answer is so complicated, I wish I was asked "What is the meaning of life". I do have a clear vision of what health care will be like in the future but don't expect a sound bite answer. My vision is created by considering many aspects of care as well as unintended consequences. Over time I will elaborate and extrapolate in a Charles Dickens-like way. We will keep politics out of the equation because political thinking is short-lived and incapable of long term problem solving. Forces that will drive the direction of health care will include technology, economics, strategic planning, and last but not least, patient efforts to take responsibility for their own health. I will tell you this. Health care will not be anything like what we are used to. But of course that depends on your age and what you're use to.

In Response to Professional Courtesy Article

Professional courtesy is not obsolete in my practice.  It is a token of respect for a colleague or allied professional that has spent countless hours away from his or her family to ease the suffering of others. But I do agree with the author that it will be obsolete.

Extending professional courtesy usually means waiving copayments.  Medicare can fine physicians for fraud because they assume the the total fee is inflated to compensate for lack of copayment.  An analogy can be make with an auto body shop that waives a deductible. The auto insurance company will certainly investigate.  Years ago, I made house calls in a local convent.  I was treated with the respect usually given to priests as they were gratefull for my visit.  I had to demonstrate a reasonable effort to bill the convent even though I felt my visits were a courtesy.

Also, these days clinicians are increasingly removed from billing practices.  Most just want to document what was done and leave the billing to others. "Just take the ticket and bring it to the cash register" will be the prevailing sentiment.  No room to wiggle there. Maybe rightfully so.