Now that Avandia Use is Restricted, Are There Low-Cost Alternatives?

Word is out that the FDA has placed severe restrictions on the use of the diabetes drug Avandia.  Thousands of people are now forced to decide what to take in its place.

Avandia isn’t/wasn’t cheap.  The knee-jerk reaction of many physicians will likely be a switch to one of several other pricy brand name medications.

Now would be a good time to evaluate whether less-expensive options should be entertained.  This might especially be true for people who were prescribed Avandia from the start, or without first trying more than one medication of lesser expense.

What You Might Lose By Using Multiple Pharmacies or Mail-Order

I recently had an informative online exchange with pharmacist Eric Geyer, BSPS, PharmD, RPh, about some of the pros and cons of shopping around for pharmacies.

While it is hard to argue against finding the best price for each medication, keep in mind the potential associated costs . . .

Savings Often Lost on 90-Day Prescription Refills

Requests for 90-day refills are becoming more the norm.  Pharmacies and insurers are increasingly offering (and sometimes requiring) bulk-quantity prescriptions.   For the consumer, the incentive is usually reduced out-of-pocket expense. 

Unfortunately, it is too easy to lose much of that savings if one is not careful.

Here are several of the ways . . .

Immediately requesting 90-day prescriptions for new medications or dosage changes.   What if the new script is ineffective or causes side effects?  Nobody wants to throw away three months of medication that have already been paid for.

Not keeping ahead of expected (and unexpected) drug shipment delays.  Cutting it too close may require that a script be filled locally to keep from running out, and the bridging refill might be more expensive than usual.

Not being mindful of when follow-up visits are expected.  When writing extended refills, your doctor very likely wants to see you back before the prescription runs out.  Suddenly realizing that you are out of pills puts you in a bind.  Your physician might allow you some additional time by calling in a month’s refill.  However, he or she will be much less inclined to provide an extended prescription if you are overdue for follow-up, sometimes resulting in the cost of an immediate extra trip to the office.

Not checking on the need for refills during unrelated office visits.  It is annoying and costly to get pulled back to the office only a few weeks later because neither you nor your doctor realized that you were soon due for follow-up of another condition.

Poor timing of office visits.  It is frustrating to throw away three months of recently-received pills because your prescription is changed or stopped.

So, here are the tips to keep in mind:

• Only seek bulk-quantity refills for prescriptions that are unlikely to change anytime soon.
• If using mail order, request shipments with plenty of time to spare.
• Presume that a follow-up visit is expected before needing a new prescription, and plan for it.
• Before any office visit check to see if any refill reauthorizations will come due before you otherwise plan to return.
• If you hope to address chronic medication refills during an unrelated visit, ask for a longer appointment.
• Schedule follow-up visits just before you will be due to request a new refill shipment.

Many people can save money with bulk-quantity refills.  It just pays more to be smart about it.

Stephen Meyers, MD