Monthly Archives: July 2010

Name Brand Statins Compete With Discounts and Samples

Cholesterol-lowering medications are a huge pharmaceutical market, dominated by statins.  Several statins are now available in generic form, but there remain three big nongeneric players–Lipitor, Crestor and Vytorin.  (Vytorin is a combination product, but does include a statin.)

Of course, each pharmaceutical company touts reasons why their drug should be chosen, and health care providers commonly recommend one of these three when cholesterol goals cannot be reached with a generic.

We can soon expect insurers to prefer Lipitor through co-pay tiering, as its patent is set to expire first.  Until that time, each company is promoting appeal for their product by way of cost.

  • All three companies offer a 30-day free trial and provide free samples profusely to physicians.
  • Crestor and Lipitor also offer savings cards.  Currently, Crestor’s program drops monthly out-of-pocket expense to $25, and Lipitor’s provides a co-pay discount of up to $15 per month.  (As with all pharmaceutical savings promotions, there are limitations on who can use them.)

Don’t be surprised if the discounts improve further.

Expect to soon see even greater efforts from Pfizer to squeeze everything they can out of Lipitor sales before it goes off patent.  Its two competitors are certainly also planning on incentives to counter insurers’ inevitable push toward the looming Lipitor generic.

The good news for consumers is that costs for these products should soon drop significantly.

Stand back and watch the fight.

Stephen Meyers, MD

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Vytorin, Crestor and Lipitor are registered trademarks, respectively, of MSP Singapore Company, LLC., the AstraZeneca group of companies and Pfizer, Inc.

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Can Self-Management of Blood Pressure Reduce Costs?

To me, it is not surprising that a recent study in the medical journal The Lancet (link to abstract) showed better control of hypertension when people actively kept tabs on their blood pressure outside of the office.  Although not the purpose of the study, there is also a monetary benefit to this practice if you have hypertension, and maybe even if you don’t . . .

Checking blood pressure measurements at home can reduce your medical costs.

Home blood pressure monitors are now widely available, relatively easy to use, and are not very expensive. 

So, how might that little machine save you money?

Checking your blood pressure periodically can help you possibly avoid the additional costs of unnecessary medication.  Normal home readings might prove that you don’t have high blood pressure in the first place.  Some people can prevent needless treatment for “white coat hypertension” (blood pressure that is high only in the doctor’s office).  People who do require medications can sometimes avoid new drugs or higher dosages prompted by one unusually high measurement at the office.

You might also be able to avoid extra office visits.  I know that I often allow longer periods between recheck visits if I know that the person is monitoring their blood pressure at home.  At times, your doctor might even be willing to make medication adjustments by phone based on outside readings, rather than insisting that you come in for a meeting.

So, here are a few tips that may very well pay off . . .

  • Bring your blood pressure monitor to an office visit once or twice yearly to confirm accuracy.  It also gives your doctor confidence that you get dependable results.
  • Be sure to check your blood pressure a few times before each office visit and record the readings for review.
  • During a follow-up visit, ask if your doctor is comfortable providing a year of medication refills if you vow to monitor your blood pressure and call with results quarterly.
  • When visiting your doctor for a different reason, provide your home measurements and ask if he or she will extend your refills out further.
  • If one of your antihypertensive medications is adjusted, call the office with results–you might be able to avoid an immediate follow-up visit.

Although some situations require especially close attention, many people with high blood pressure can realize significant benefits from this simple practice.

Better care and reduced costs.  What’s not to like about that?

Stephen Meyers, MD

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If Your Doctor Botches a Prescription, Should You Have to Pay For It?

Have you ever opened a prescription bottle to find the wrong pills inside? 

If so, you may have found it to be an expensive mistake. 

Whatever the reason for the error (and there are numerous possible causes), here is how to best handle the situation . . .

Of course, it is always smart to confirm the medications, quantities and dosages at the pharmacy checkout.  A mistake recognized at the time of purchase can be easily corrected.

It becomes more of a problem if you discover the error after you are home.  Due to concerns of tampering, pharmacies will not usually allow return of medications that have left the store, especially if the bag or bottle has been opened.

Once you notice the mistake, your pharmacist should be able to quickly make things right, but the payment side can be tricky.

  • If not covered under insurance, full payment for the corrected prescription may be necessary, even though you paid for the first.
  • Even if insurance covered some or all of the first prescription, you may be responsible for a second co-pay, or even full price of the replacement.

If you are faced with possible extra expense, first ask your pharmacist how best to handle it.  There may be an insurance protocol for this very situation, although the solution might not be immediate.  Some pharmacies might decide not to charge you for the corrected prescription, especially if they contributed to the error.

If the physician’s practice appears to be the culprit, don’t immediately call for the doctor or nurse–the office manager is the person to call.  Keep in mind that they will need to look into the situation to find out what actually occurred on their end.  If it truly was an error on their part, you can expect an apology and reimbursement for your extra costs.

Stephen Meyers, MD

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Is There Even a Debate About Generic Drugs Anymore?

Just a few years ago people seemed to despise generic medications.

The simple mention of a generic would prompt my patients to draw back, indignant that I would even suggest what they considered to be inferior treatment.

How times have changed.

Today I can barely finish typing a prescription (we don’t write them anymore, you know) before the recipient asks, “That’s a generic, isn’t it?” 

In my area the tide shifted dramatically when a major insurer temporarily eliminated co-pays for generics.  It is one thing to save a few bucks at the pharmacy, but the prospect of “free” won over even the most wary of medical consumers.  Even for others, the cost savings of generics is often too great to pass up.

Yet, suspicion still lurks in the shadows.  Many people who have switched to generics for cost savings still believe that they are taking second-rate medications.

Are their concerns justified?

Critics cite the fact that a generic is not an exact duplicate of the parent drug, which is true.  Although the active ingredient is the same, there is allowance for some variability in dosage, as well as fillers and dyes.

Is this disparity of great concern?  It depends on the situation.

[Analogy enter stage left.]

Like everyone else, I must visit a gas station every week or so.  I know very well that premium gasoline is the best for my car (at least that’s what they tell me.)  However, I always fill up with “regular.”  Why?  Well, it adequately propels my car to where I need it to go, and has yet to cause any obvious problem.  I reason that switching to premium gasoline would not improve my situation enough to justify the extra expense.

Similarly, the variations between generics and their name brand counterparts are small enough to make little difference in most situations, but there are possible exceptions.

  • Drugs with a narrow therapeutic window (doctor speak for medications that can be ineffective or have adverse effects with minor changes in dosage.)  A clue that this might apply would be the need for periodic blood tests to measure levels of a drug.
  • Situations with dire consequences should dosing be inappropriate.  Blood thinners and anti-seizure medications can fall in this category.
  • People who notice side effects or lack of benefit upon switching to a generic.  This is often unrecognized today, since people often try generics from the start.
  • Unexplained variations in benefit/effect from month to month.

In the absence of the above scenarios, most people do just fine saving money by taking generics.

Of course, everyone has the option of insisting on name brand medications, just like they can pay for “premium” at the pump.

Stephen Meyers, MD

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Defensive Medicine Is in the Eye of the Beholder

Today I was on the lookout for a cost-saving topic to write about, on the heels of my blog debut last night.  Sometimes life delivers inspiration, and then adds an exclamation point.

One of my morning appointments involved a nice man complaining of recent heartburn.  An OTC medication provided him complete relief, but the package recommended that he consult a doctor before taking it for more than two weeks.

“Can I stay on it?” he asked.

Doing my job to be cautious, I peppered him with numerous questions and found him to be the poster child for uncomplicated, run-of-the-mill heartburn.  He had absolutely no risk factors or warning signs for a more sinister problem.  I easily see a half-dozen people like him each and every week.

I explained that the intent of the package warning is to keep people from masking the symptoms of a more serious condition, thinking that everything is okay.

Only a tiny number of people with uncomplicated heartburn turn out to have cancer, I told him, with most primary care physicians only seeing a handful of cases in their entire career.  I still offered to arrange a barium swallow or endoscopy to be extra careful, but he decided not to undergo further testing unless the medication proved inadequate, or he developed worsening symptoms.

Knowing that defensive medicine is a hot topic, I decided during my lunch break that this man’s situation provided a perfect example.  Although the term “defensive medicine” implies a physician ordering tests only to avoid a lawsuit, more often the intent is simply to be thorough in providing the best care.

It can be challenging to decide when prudent evaluation becomes unnecessary expense.

Although extreme caution might dictate that cancer be assumed until disproven, I knew that this man’s situation would almost certainly turn out well.  If I were to order expensive and unpleasant tests for every case of heartburn, I would likely be accused of practicing defensive medicine, rather than applauded for rendering exceptional care.

Having decided upon the topic for my article, I returned to my afternoon work.

During a slow moment I decided to catch up on the growing pile of mail received.

Among the various lab results and letters from consultants was a pathology report for another man whom I take care of.  The diagnosis was adenocarcinoma (cancer) of the stomach.

I now wonder if I should approach tomorrow’s heartburn sufferer any differently than I did today?

Stephen Meyers, MD

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Can One Really Blog About Medical Savings?

The cost of medical care is one of the top issues we face today–not only for individuals, but also for health care providers, employers, insurance organizations, pharmaceutical companies and the government.

As a physician on the front line, I see how each player is impacted by actions of all the others.  While it is easy to point fingers and blame someone else for escalating costs, in reality everyone is responsible to a degree.

From my perspective as a health care provider, I most commonly deal with the plight of the individual.  On a daily basis I see people avoiding or delaying care due to cost.  Decisions about medications are frequently made based more on expense than benefit.  In an unfortunate form of irony, it is not uncommon for these same people to unknowingly make decisions that actually increase their costs in the long run, or waste money outright.

One of the primary problems is that individuals do not really have an advocate to help them cost-effectively navigate the complex health care system.  Physicians strive to provide them top-notch care, but simply don’t have the time to  explain (or even themselves understand) all the ways that treatment decisions may impact cost.  Pharmacists often help find less-expensive alternatives to individual medications, but they are busy, too.  Various resources do exist to help with cost, but are often not widely known and commonly apply to limited situations.

Do I have the solution for all of this?  Well, not entirely.  However, each and every day I find situations where I am able to help people to save on their care.  I don’t mean just telling everyone to switch to generic medications and order prescriptions in bulk quantities.  Sometimes it is making people aware of savings promotions or cost-cutting resources.  More often it is helping people to understand how they can manage their conditions more cost-effectively, or avoid unnecessary tests and office visits.  Sometimes it is a simple as evaluating whether a particular medication is still needed.

Years ago I would encounter an occasional patient lamenting their medical expenses.  Today it is unusual to run into a person not concerned about cost.  Suspecting that there might me a wider audience than my work day provides, I have decided to see what happens with a blog devoted to the issue.

I do not propose to adhere to any particular format.  I expect it will be a mix of brief articles, links to helpful resources, and observations from my day.  Each will be from the angle of reducing medical expenses without sacrificing the quality of care.  Perhaps in aggregate they will help not only individuals, but also the other players.

I am excited to see where the journey leads us.

Stephen Meyers, MD

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