Monthly Archives: August 2010

Doctor Gets a Bit of Own Medicine

I should be hard at work right now seeing patients in the office, and I would be if it weren’t for one little pill.

Have you ever been frustrated by a physician refusing to give you an antibiotic?  That very scenario occurs daily in primary care.

“It is only a virus.”

The arguments against taking an antibiotic (cost, side effects, allergic reaction) can seem less than convincing when you are feeling sick.  Also, one little prescription is unlikely to have global impact on the antibiotic resistance of bacteria.  Watchful waiting is never what you go to the doctor seeking.

Today I was reminded why I must respect the potential wrath of a drug.

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Newly-Covered Preventive Services: Are Docs in the Dark?

In just one month, as a part of health care reform, many more preventive services will be covered by health insurance.  Have the care providers been left out of the information loop?

I find it odd that I, a provider of many of these newly covered services, have received not one communication (letter or otherwise) about the changes.

Patients will certainly ask physicians about the new insurance coverage requirements.  What are we to tell them?  Since the changes are to take effect so soon, it would seem that  I should already know the criteria for coverage.  Do I just claim ignorance and tell everyone to call their insurance company?

Are my chart documentation, coding or billing supposed to change in any way to accommodate the new coverage?  Surely there will be boxes for me to check or special forms to fax–there always are.  I can’t believe that it will simply be business as usual.

Personally, I think that coverage of these services is a great thing.  I have always had tremendous respect for the USPSTF guidelines upon which the new coverage is based.

But am I the only doc in the dark?

Stephen Meyers, MD

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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

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Filed under Managing Medications