Category: generic drugs

Medicare: It’s better than nothing

medicarecartoon

I am extremely fortunate to be as healthy as I am at my age, considering I’m a champion couch potato and computer addict. My health care consists primarily of semi-annual doctor check-ups, some routine annual tests, and a fistful of prescriptions (knock wood). It’s that last part that really has me po’d right now.

Medicare Part D. The prescription “coverage.” What a joke. I’ve been thinking I like the HMO I’m with. They have real live people — polite, friendly people — answering their phones and my questions. Turns out they can afford to be friendly.

They send out quarterly statements of what they’ve paid on prescriptions. Nice, I thought. Detailed breakdown of every script filled, name, date, amount, how much it cost, how much they paid, how much I paid, and totals. I dutifully tuck it away somewhere in case I need it for reference, taxes, or whatever. (I developed a severe allergy to numbers in my childhood, and if I don’t keep my exposures brief, my head starts to swim and my eyes cross.)

Okay, bottom line. You’ve heard of the “doughnut hole,” right? I have initial coverage up to a total of $2700; then the infamous doughnut hole kicks in, and until my total costs reach $4073.13, I have no drug coverage. Period. (I have absolutely no idea where they came up with those numbers.) I live in fear of the $2700 mark and the doughnut hole. I watch those totals like a hawk, guesstimating whether I’ll stay under $2700 for the year.

What I was overlooking until a few days ago was that when my pharmacy submits a claim on one of those $4 generic scripts, the HMO pays $0, zilch, nada, yet still counts it as $4 toward that $2700! Doh. How stupid am I. (That is a rhetorical question, which means you, dear reader, aren’t supposed to answer it!)

Several more scripts caught my attention. A whole 65 cents paid on a $9.65 refill. $7.06 paid on a $47.06 script. Except for the generous payments on the eye drops I have to use, I might as well not have prescription coverage. But of course I keep paying the premium because one of these days I’ll probably need what amounts to catastrophic coverage.

Ever friendly, this HMO sends out a nice little quarterly newsletter chock full of helpful articles on maintaining good health, keeping medical costs down, etc. The last issue had a little item on the front page headlined “How to Save Money on Your Prescriptions.”

It started off saying the $4 generic prescriptions are a great savings opportunity for members! (The exclamation mark is theirs.) Then it says it’s very important to instruct the pharmacy to bill these claims to them. Why? Because if we the members pay cash for these prescriptions (which we do anyway), the HMO’s data will not show that we’re taking that drug and the cost of that drug “will not accrue toward any deductibles, and medication reviews for cost savings or therapeutic suggestions will not be accurate.”

Furgit that! Sorry, dear HMO, but if you aren’t helping me pay for these drugs, it’s none of your damn business. My pharmacist, my doctor, and I have a good grasp of both savings and therapeutic suggestions. You are not a participant here; you are a third party. You can and do choose what you will pay for, but the decisions are ultimately mine, not yours.

Nor does some Medicare pharmacist in Washington need to feel responsible for my “medication therapy management” or need to have “all of the information” to help me “manage” my drug regimen. I have a doctor, thank you very much. And I have a very competent pharmacist who keeps track of everything I take and warns me of any possible adverse reactions or interactions (on the off chance the doctor might have overlooked something).

You, dear HMO/Medicare, are an insurance company. Nothing more. You do not dictate my medical care. You do not make my medical decisions. Your job is to help me pay for the health care I choose. And so far, you’re doing a pretty mediocre job of that.

Polypill no panacea

pillsMy son called me when the story broke.

“Hey, Mom, have you heard? There’s a new pill that can cut your risk of heart disease and stroke by 80%! It’s a combination of drugs … ”

If only it were that simple. I shudder to think how many people out there, far less educated than my son, have heard about this latest “magic bullet” and gotten their hopes up. I hate pharmaceutical marketers; I really do.

First, like most drug studies I’ve ever read or read about, this one was funded by the company that makes and hopes to market the drug being studied. In this study, it was the “Polycap” capsule made by Cadila Pharmaceuticals. Often the media doesn’t report this, so unless you have access to the original report, you won’t get that information. Even if Cadila doesn’t reap huge profits from combining a bunch of generic drugs into a single generic pill, you can bet they won’t walk away empty-handed either. Their particular combination is — tada! — a new drug.

And as always, when a pharmaceutical company funds a study of its newest wonder drug, I immediately suspect the objectivity of the study and its results.

Okay, granted, it might be convenient to have a 5-in-1 pill. Proponents argue the convenience will improve patient compliance. Maybe.  Maybe not. If my doctor tells me to take a pill every day to prevent a heart attack, chances are excellent that I’ll take that pill every day. Or five pills, if that’s what he tells me. And if I’m going to skip doses anyway, what difference does it make if I’m skipping one pill or five? One report commented on how large this megapill might be; without doubt, a big, hard-to-swallow pill would be a far greater obstacle for me than five little pills.

I suppose the researchers deemed this particular polypill safe because its component drugs don’t interact with each other in an adverse way. (It won’t poison you or explode when the ingredients mix.) But being “safe” is more complicated than that.

… combining the drugs into one tablet delivered a similar effect to each drug separately.

Now there’s a news flash for you.  It took an expensive scientific study to determine that? Those drugs have been prescribed in combination for years!

Reductions were seen in both blood pressure and cholesterol without any major side effects.

Golly gee. The pill’s component drugs are commonly prescribed to reduce blood pressure and cholesterol. Is it news that they still do so when squished into one pill? As for no major side effects … I suppose it depends on your definition of “major.” To me, eventual blindness is major. The Polycap contains a beta blocker, which would upset the very carefully adjusted doses of the two drugs I use to stave off glaucoma.

The components of the “Polycap” polypill are:

  • Aspirin to thin the blood
  • A statin drug to lower cholesterol
  • Three blood pressure-lowering drugs:
    • ACE inhibitor
    • Diuretic
    • Beta-blocker
  • Folic acid to reduce the level of homocysteine in the blood, another risk factor for heart disease

I can’t imagine the headaches of trying to figure out who should and shouldn’t take this newest “miracle drug.” A competent doctor is going to consider a number of factors when deciding which particular drug or combination of drugs is right for you and what the dosage(s) should be; I’d be seriously concerned about any doctor who just takes a shotgun approach with this polypill.

You can’t just pass these things out like candy and end stroke and heart attack in our time. The odds might be favorable in a population that otherwise gets no medical care at all. But what happens when a patient would benefit from some of the drugs but be harmed by others? What if the dosages are not ideally balanced for the individual? If there’s an adverse reaction, how do you determine which component(s) was the cause? Do you sort through the individual components to figure out where the problem is? Or do you just discontinue the pill altogether, throwing the baby out with the bath water?

I’ll wager most people over 55, if they are at the slightest risk of stroke or heart attack, are already taking a baby aspirin (81 mg) every day. And if they take a daily multivitamin, or eat the right foods, they’re already getting folic acid.

I’ve written before about over-the-counter drugs that contain multiple ingredients, some of which the consumer may not want or need.  I prefer to pick and choose the single ingredients I want.  The polypill is a much more complicated example of a combination drug. If it ever gets to market, doctors and their patients are going to have to be on their toes. It’s not a panacea. It cannot just be presecribed willy nilly to every person over 55 and magically eliminate half of all heart attacks and strokes.

We should view pharmaceutical studies and marketing with a very critical eye; we should do the same when medical reporters interpret study results for us. For that matter, you should be critical of my writing. If you can’t find, read, and understand the original study for yourself, talk with your doctor. Please, please, please do not rely solely on mainstream media for your health and medical information.

$4 generic prescriptions: a bargain or just sleight of hand?

Wal-Mart started it. The $4 generic prescription deal. Saves hundreds of dollars for millions of patients. Or does it?

Recently my supermarket pharmacy joined the $4 prescription parade so I’m finally going to get an up-close look at all the hoopla. Until now, convenience has trumped price shopping, and I haven’t been willing to drive to Wal-Mart for my scripts.

When I picked up my refills last week at my supermarket’s pharmacy, the first thing I noticed was that I was charged exactly $4 for the least expensive refill. Curious, I checked my old receipts when I got home and, sure enough, previously I’d only paid $1.52 for the same drug.

Having recently changed insurance plans, such comparisons are going to be a bit complicated for me. But however it shakes out, it got me thinking. Retailers of all kinds are in business to make a profit. They don’t give you something for nothing. So, Thought #1: A lot of old generic drugs have cost less than $4 for a long time. Have their prices now been raised to the magic $4? And Thought #2: How much have the prices of higher cost drugs — generics not on the list and brand name drugs — been raised to offset any actual losses with the $4 drugs?

I picked up a slick little brochure listing all the drugs on my pharmacy’s $4 list. It made interesting reading. The first thing I noticed were the non-prescription drugs that have been available over-the-counter (OTC; without a prescription) for years. Guaifenesin DM (guaifenesin with dextromethorphan), an expectorant/cough syrup combo, is available OTC as Robitussin DM, Musinex DM, and a generic. I don’t know if it’s cheaper from the pharmacy or off the store shelf, or if the strength is the same. Certainly that should be checked out. On the other hand, the last time the doctor gave me a prescription for Musinex DM and I presented it to the pharmacist, she referred me to the boxes out on the store shelf.

Another drug on the list is ibuprofen, in three different strength tablets and a liquid. The name is as ubiquitous as aspirin for most adults, because it has been available OTC as Advil and in generic form for many years. If the dosages don’t match the strength your doctor recommends, adjust accordingly by taking more or less. Unless, of course, the pharmacy’s $4 is a cheaper way to go; but won’t that require a prescription from your doctor? Is it worth it to you to get a prescription?

Naproxen (aka Aleve), another pain reliever and anti-inflammatory, also appears on the list. It, too, is an OTC drug, available generically. The same is true with ranitidine (Zantac), a stomach acid reducer.

Loratadine is on the $4 list. It’s sold OTC as Claritin or Alavert, an antihistamine. Recently it has become available OTC as a generic, too. So which is cheaper, off the shelf or from the pharmacy? And if you get an actual prescription, is the pharmacist going to fill it from her stock, or direct you out to the open store shelf? If you then buy it off the open shelf, will you pay $4 because you had a script, or will you end up paying more (or less)?

Further complicating the picture is the issue of generics vs. brand names. In the past there has been great concern that generics were less effective than brand names, or perhaps of lesser or varying quality. I shared that concern for a long time, perhaps because I was so close to the world of medicine and Big Pharma. Without question, it was to Big Pharma’s advantage to promote this thinking and keep us buying their brand names. Today, though, with my budget being as big a concern as my health, I’ve taken a wider view; generics, after all, are regulated by the FDA (for whatever that fallible agency’s regs are worth).

Bottom line, I don’t believe Big Pharma is sitting idly by while $4 price plans reduce their profits. And pharmacies still have to buy their stock somewhere. And they all want to make a profit. So call me crazy (it wouldn’t be the first time), but I have my doubts about how much the pharmacies are actually saving us with these $4 drug programs.

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