More using strategies to cut cost of drugs

Studies: 1 in 5 adults skip doses to save money

Sunday, May 19, 2013
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— When Charlie Sweeney couldn’t afford to fill his prescriptions, he’d resort to free samples. When free samples weren’t available, he’d go off his medications cold turkey.

It forced him to find other ways to cope with his depression. He tried exercising more and drinking less. He tried eating more vegetables, and at times, he wondered if he even needed medication at all.

“It’s viewed a lot differently when you have a psychological-based illness because the side effects aren’t spiking a fever,” said Sweeney, 36, of Albany. “They’re [an] inability to concentrate, or fatigue and sleeplessness, or just a plain negative outlook.”

But sometimes they’re worse. People who forgo beta-blockers can end up with high blood pressure, and HIV-positive individuals who take their antiretroviral drugs sporadically can develop resistance to those medications. People who skip medications for depression can increase their risk for suicide.

Any missed medications can lead to poor health, increased emergency room use, hospitalizations and unexpected cardiovascular events.

Sweeney is among the one in five adults who skip medications or don’t take them as prescribed to save money. Last month, the federal Centers for Disease Control and Prevention released data from a 2011 National Health Interview Survey that found adults are using any strategy they can to reduce prescription drug costs.

For some, this means skipping a dose here or there. For others, it means cutting a dose in half. A fifth of all adults ask their doctors for low-cost generic medicine in place of brand-name drugs. About 6 percent will seek alternative therapies, and 2 percent will buy drugs from other countries to avoid high prescription costs.

Sweeney honed his own strategies over the years. His doctors first prescribed anti-depressants seven years ago, trying a handful of different drugs before finding the right one for him: Wellbutrin.

Now a reporter for The Record in Troy, he wasn’t always fully employed. During the times he was between jobs, he had no insurance to cover even the generic version of the medication, Bupropion, which cost about $140 for a 30-day supply.

“I’ve been on and off this medication for at least five years,” he said. “And, yeah, sometimes I’ve gone off it because I felt like I didn’t need it. But other times I’ve gone off it because I was between jobs and I didn’t have health coverage and I couldn’t get Medicaid coverage and I simply couldn’t afford it.”

He learned quickly, however, that doctors receive free samples of new drugs on the market from pharmaceutical companies. Before a doctor will prescribe these to a patient, they ask them to take samples first to see how they work.

“So I would go and see my provider, explain my situation, and they would start me on a free sample when they knew I couldn’t go through insurance,” said Sweeney. “Sometimes, they would refer me to a different provider, knowing that a psychiatric nurse or some other practitioner would say, ‘Make an appointment with my friend over here because they have a few months worth of free samples.’ ”

But many physicians have stopped doing this, said Dr. Fred Venditti, vice dean of clinical affairs at Albany Medical Center and president of Albany Med Faculty Physicians.

“The medicines that are available in samples tend to be the latest, greatest, more extreme medicines,” he said, “so it might help to give someone a sample for those two weeks. But when they need to fill that prescription, you’re looking at $200 a month, so it doesn’t really help.”

And physicians who dole out free samples are taking on the role of a pharmacist.

“You have to be really careful how you dispense medicines,” said Venditti. “You need to track them, you need to know their lot number, who you gave it to, and sometimes medicines get recalled. I’ve seen lots of medicine come on the market and they seem like they’re great and then there’s a problem. So I tend to be conservative. I personally tend to use long-acting drugs that have been around for a while.”

In 2011, Americans spent $45 billion out of pocket on retail prescription drugs. Not surprisingly, the CDC study found the adults most likely to skip doses and delay filling prescriptions were the poor and uninsured.

Uninsured adults up to age 65 were 23.1 percent more likely than those with Medicaid or private coverage to try to save money by skipping medications. Even adults with some coverage, such as those 65 and older with Medicare, were more likely to ask around for lower-cost medications than their privately or Medicare/Medicaid-covered peers. The uninsured were also more likely to use alternative therapies in an effort to save money.

The poor and uninsured are easy for Venditti to spot.

“They come armed with a list of medicines that you can get at Walmart for just a couple of bucks,” he said. “They know they’ll need to get a prescription, and they already know they’re going to have a hard time affording it, so they come pre-armed.”

Albany Medical Center conducted its own study a few years ago, similar to the CDC study released last month. Its findings were identical, with one in five patients admitting they had skipped medication or delayed filling prescriptions because of their cost.

The 2011 study was commissioned after the recession hit and more and more Americans began avoiding needed health treatments to save money.

With nearly half of all Americans on at least one prescription drug, the recent CDC study has raised an alarm among health care officials working diligently to reduce hospitalization and readmission rates. Reducing these rates is the easiest strategy for reducing health care costs, since readmissions of the chronically ill are often the costliest visits. And a sure way to end up back in the hospital is a missed dose or improper use of medication.

Ideally, Venditti said, a patient will be upfront about their financial ability to fill prescriptions on time. But after Albany Med shared the results of its study, he realized at least one in five of his patients were lying to him.

“Twenty percent of my patients aren’t taking their medications, which suggests to me they feel I’m going to yell at them or scold them, or they’re embarrassed or something else we don’t yet know,” he said. “If they skip, and I don’t know they’re skipping, that’s a real problem.”

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May 19, 2013
7:29 a.m.
ronzo says...

Surprised that only 2% get scripts off shore. We get most of my wife’s from pharmacies in Australia and India. They are delivered by mail in the original packaging from U.S. drug manufacturers like Novartis, East Hanover, NJ; Eli Lily, Indianapolis and others. Their cost is about 25% of the cost here through our health plan. Plus the Australian and Indian governments have much stricter pharma regulations than our FDA which is pretty much owned by the pharmaceutical industry.

May 19, 2013
12:56 p.m.
Fritzdawg says...

ronzo: It's possible that many people bought into the lies that the pharmaceutical industry told when they spread the word that drugs bought overseas are usually fake, and sometimes poison.

May 19, 2013
5:09 p.m.
ronzo says...

Fritzdawg: And who perpetuates those lies but our own FDA, whose only interest is enriching the drug manufacturers, because the FDA IS the drug industry that provides mega bucks to political campaigns. At least in India and Australia their pharma regulators are bureaucrats and not CEOs of drug companies. That's why you can buy a Novartis brand drug from an Indian pharmacy by mail for 25% of what Caremark charges you for that same drug by mail here. You can get a brand name drug off shore for less than what you pay for a generic here. If more people knew this maybe they could afford to take their pills every day.

May 19, 2013
7:16 p.m.
Fritzdawg says...

The healthcare and pharma industries spend $5.4 Billion per year on lobbying.
That's almost twice of what the defense industry, and the energy industry spends COMBINED.

Never in history has it been so glaringly obvious, that the government can be bought.

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