By Kate Kellogg
Human Resources/Affirmative Action
Health care organizations and employers are implementing cost-sharing strategies that enlist members help in managing the costs of prescription drug benefits.
Physicians increasingly incorporate cost along with quality considerations in their choice of prescriptions. Pharmacists save money for patients and health plans by suggesting generic drug substitutions for equivalent brand-name drugs.
Still another important player can help control spending and ensure effective use of prescription drugs. That person is you, the consumer of those products.
Patients have both the capability and responsibility to exercise good judgment in the purchase and use of prescription drugs. The following suggestions are taken from patient education materials distributed by Care Choices, M-CARE and Blue Cross/Blue Shield of Michigan.
Communication is the key to success in using your employee prescription drug benefit. If your doctor does not provide much information about the prescription, beyond it should take care of the problem, ask the following questions:
If you miss any of those questions in the doctors office, you have a second chance to get the information from the pharmacist. In fact, many pharmacists voluntarily provide more details about prescriptions than do busy doctors.
Back to the doctor: Older patients or those who have difficulty remembering dosage times and quantities should ask the doctor or nurse to clearly write out those instructions.
You also can assist your physician in prescribing the safest and most effective drugs for you by providing information that doctors dont always solicit. You should mention:
Once youre at home with the medication, the next important step is seemingly simple: take it as directed. Yet up to 50 percent of patients do not take medication the way their doctor prescribes it, according to M-CAREs HouseCall Newsletter. Noncompliance occurs across all age, sex, ethnic and economic groups, and accounts for more than 125,000 deaths annually. Medication noncompliance costs more than $100 billion annually in avoidable hospitalization and lost productivity.
Many patients stop taking their medication as soon as they feel better. Others with serious problems, such as high cholesterol, feel well and dont remember to maintain their course of treatment. Others adjust their dosage without consulting their doctor. Noncompliance is less likely to occur with patients who thoroughly understand the purpose of their prescriptions.
Consumers can even participate in efforts to manage prescription drug costs. Your use of generic drugs whenever possible will save money for both you and your health care plan.
The contracted pharmacies of many HMOs, including M-CARE, now dispense a generic equivalent of a brand-name counterpart unless the prescription indicates DAW (dispense as written). They generally cost 40 to 60 percent less than their brand-name counterparts.
If your plan offers the lowest co-payment for generic drugs, you are probably already aware of that difference. Most managed care plans encourage physicians to prescribe therapeutically equivalent generic drugs over brand names. But it never hurts to ask the pharmacist if a generic substitution is available for a brand-name drug your doctor has prescribed.
Another way to save on co-payments, as well as trips to the pharmacy, is through a maintenance drug program. For example, M-CARE authorizes its participating pharmacies to dispense 90-day supplies or 100 doses (whichever is greater) of certain drugs prescribed for chronic conditions. The normal limit is a 34-day supply.
You can receive the larger quantity on one prescription if your drug is included on the M-CARE maintenance drug list and if your physician orders that quantity. Reviewed and updated annually by the M-CARE Pharmacy and Therapeutics Subcommittee, the maintenance drug list is on the Web at www.mcare.org.
As an informed consumer, you have the right to ask your doctor about prescription drugs that interest you. However, if your information came from advertisements, remember that the pharmaceutical companies that pay for these ads hope to profit from your interest.
Direct-to-consumer advertising for prescription drugs last year cost the pharmaceutical industry $1.3 billion, a 16 percent increase over the previous years expenditure. Consumers need to understand how to use this commercial information, says Art Poremba, manager of ambulatory pharmacy services for the Health System.
The pharmaceutical companies say they want to make people aware of whats available. But the information they provide through magazine and television advertising needs to be interpreted in the context of other drugssome of which may be clinically superior and more cost effective, Poremba says.
So be a discriminating, even skeptical consumer when you see an ad for a drug that looks like the cure-all for your ills. Consider taking the following measures:
Good patient-doctor communication provides real possibilities for containing prescription drug costs and using drugs more effectively, believes John E. Billi, associate dean of clinical affairs at the Medical School.
I think a lot of physicians and employers are under the misconception that patients dont care about cost as long as they get good coverage, he says. To patients who have flat co-pays, I explain why unnecessarily expensive drugs are not good for anyone. I explain that they are sending dollars to pharmaceutical companies, dollars that could otherwise provide health care for their community and keep their insurance premiums low.
Ive never found a patient who responded, I dont care.
For more information, visit the Web at www.fda.gov/opacom/catalog/medtips.html (FDAs Tips for Taking Medicines) or www.ahcpr.gov/consumer/ncpiebro.htm (Prescription Medicines and You).