My Prescription Costs How Much???

Every day innumerable prescriptions are written and placed in the hands of patients. What happens next? This vignette explains what happens commonly in this country.

Keep in mind I have a great deal of experience in medications used to treat illness and a familiarity with the current costs of most medications due to my current career experience. Joe may be fiction but the prices are not.

Joe is a 57 year old diabetic. He has been given prescriptions for insulin, syringes, lancets, a glucose machine, test strips and two oral medications from his doctor. He goes to his local pharmacy and drops off the prescriptions.

When he goes to pick them up he realizes that the cost is going to be in the neighborhood of $30.00 for the machine, at least $60.00 for the test strips for a month, 10.00 for the lancets, 7.00 for the syringes, oral medications (basic $4.00 department store pharmacy to hundreds of dollars for many others on the market) and Insulin (cost is just over $40.00 per vial for regular insulin to hundreds of dollars per vial for other types of insulin).

The very least he will spend for that month's worth of medicine and testing supplies is $115.00. Most likely his pills won't be amongst the low cost offerings at the department store and his insulin will cost much more than the example. Most diabetic meds are not offered on the low cost formularies.

He will also have an office visit to pay for and, due to the usual co-morbidities found with diabetes, down the line will be paying for medication to control cholesterol and blood pressure and his doctor will most likely prescribe medication with a dual purpose that tends to protect the kidneys from the ravishes of diabetes.

So....... what happens when the consumer has good insurance? He has a copay of ten or twenty dollars a prescription. He might think he's paying too much but having insurance brings the bill down significantly. If he accepts generics, where available, it will save him money.

Now...... what happens when the consumer has no insurance? If he has a job or a source of income and can afford it he may get the ones on the department store formularies and skip the insulin and testing supplies. If the doctor instructed him to test his blood sugar three times a day he may only test once. He makes decisions based on a analysis of his resources.

If he doesn't have a job, has a low paying job or has to spend every last penny on food, shelter and utilities he may skip purchasing the medications altogether.

Choosing either of these two options leads to undesirable outcomes. Depending on the coping skills available to the consumer he may become depressed or angry due to his inability to take care of himself. Not controlling his blood sugar has health consequences too.

If he applies for a new job to improve his income there is commonly a waiting period of several months and some limit coverage of pre-existing health problems.

In home care I met creative husband and wife teams who shared medications or who changed their every twenty-four hour meds to a thirty-six or forty-eight hour schedule.

If Joe cannot afford his medications what might I suggest to help Joe and his doctor? They should review printouts of the available formularies from all the major department stores and drugstore chains in the office since many have plans to cover the older, tried and true, cheaper medications.

Joe's doctor should know the approximate costs of the drugs he prescribes After all he is the main person who can determine if a cheaper (more affordable) drug is metabolically equivalent.

The doctor's office should have a list of the most current resources to help patients get meds at reduced cost or free. Some manufacturers have programs to apply to. Some doctors and nurses do provide this info and some are unaware that such resources exist.

The doctor must ask the patient about his insurance or ability to pay for medication. Many doctors do not have this conversation with their patients. Nurses are good at ferreting out this sort of information.

If this discussion doesn't occur Joe may not tell his doctor he cannot afford to fill the scripts. If his labs or exam results are bad the doctor may whip out his prescription pad and write for yet more medication that Joe cannot afford. Joe may be labeled as "non-compliant" when that isn't the true reason for him not following his doctors instructions.

The system is broken. It works for some people and against many others. We need to find ways to fix that.