Everybody who lives in NE Montana knows the burden of fighting dry skin especially in the winter given our very dry air. This author is no exception and speaks from both professional and personal experience. This time of year I almost daily see folks coming into my office asking about rashes that turn out to be dry skin and do not need a prescription as must as proper skin care.
To begin our discussion we must first understand that we cannot actually "moisturize" our skin effectively but can only effectively do things that trap our body's natural moisture in. Our body was designed to do this with our skin oils. We are all big on trying to get the proper soaps and body/face washed to help remove as much oil from our skin as we can but this is the worst things we can do for dry skin. Since we don't want to be oily we need to come up with the balance of keeping our skin lubricated without being a "grease ball."
The advice I give patients in my office is a combination of:
1) Shower no more than once a day unless absolutely necessary. Showering, especially with hot water, is one of the worst things we can do for drying out our skin. The only thing that dries us our more is soaking in a hot tub. When it comes to babies I recommend bathing no more than two or three times a week.
2) After showering pat dry with a towel, don't rub. Rubbing removes more of those natural oils that help hydrate our skin and further irritates already irritated skin.
3) Before you open the bathroom door and let the steam out apply lotion everywhere. The best moisturizer is Vaseline but it's obvious why most people do not want to use this one. I recommend Cetaphil, Eucerin or CeraVe. These are a little more expensive but are engineered to moisturize without increasing acne. All three are available locally and the first two are available in large sizes at Costco in Billings. Cheaper moisturizers often are more silky smooth but that is because they are water based rather than oil based so they do not trap in any of your body's moisture and their effects wear off after an hour or so. Many people will need to moisturize twice a day but with a good moisturizer few people need to do more than that.
I have found that these things will take care of most dry skin and prevent eczema from returning. If this does not work for you or you have questions I would be happy to discuss your individually situation. Just cal the Glasgow Clinic to schedule.
Saturday, December 8, 2007
Who Really Needs A PAP Smear Anyway
One question we often get ask at the Glasgow clinic is, "Do I really need a pap smear?" So to answer that question I wanted to start with talking about why anybody needs a PAP smear. The purpose as most people know is to screen for cervical cancer. Most cervical caner is related to HPV (Human Papiloma Virus) which is sexually transmitted. This virus causes irritation that leads to cancer so we try to screen to detect it early while it's at a very treatable stage. This leads to three questions:
1) Who needs to be screened?
2) How often do we need to screen?
3) When can we stop?
Today I am not going to address what an abnormal PAP means as this varies quite a bit and should always be discussed in the office with your doctor on a case by case basis.
To answer the first question, who needs to be screened. There are three different professional organizations who weight in on this topic including the American Cancer Society (ACS), the American College of Obstetrics and Gynecology (ACOG), and the US Preventative Services Task Force (USPSTF). All three recommend that we start PAP smear screenings three years after the onset of sexual activity or at the age of at the age of 21, whichever is first.
When it comes to how often women need screened the answer is a little more complex. For most women the answer is every year until you have had three negative PAPs and then every two to three years after that. For women at high risk screening may need to be more frequent. High risk means usually includes having multiple sexual partners or having a history of positive PAPs in the past.
The third question that women want to know is when can I stop getting these tests. The answer is not very well defined. The three above mentioned organizations all pose slightly different opinions. In general they say that women who meet all three criteria below NEVER need to be tested again.
1) Age 65-70
2) Have had at least three negative PAPs in the last 10 years.
3) Are not at high risk.
For this purpose not at high risk means sexually active only within a long term mutually monogamous relationship without a history of cervical or related cancers. We can also stop all PAP smears for women who have had a complete hysterectomy who do not have a history of cervical or uterine cancer.
The final word that I would like to add is the new vaccine Gardasil. This is a vaccine created to prevent HPV infection. It is available for women and girls ages nine to 26. It is a series of three shots that prevent the most common types of HPV and therefor prevent the majority of cervical cancer. It does not prevent all cervical cancer. This is heavily recommended for girls age 13-16 because to be most effective girls need to receive the vaccine before sexual activity. Currently most insurance companies in our area cover this vaccine and it is available through the Glasgow clinic so feel free to ask about it. More information about this vaccine is available at www.gardasil.com.
As always if you have any questions about any of the above material pleas schedule a visit with us at the Glasgow Clinic and we will be happy to discuss these things with you.
1) Who needs to be screened?
2) How often do we need to screen?
3) When can we stop?
Today I am not going to address what an abnormal PAP means as this varies quite a bit and should always be discussed in the office with your doctor on a case by case basis.
To answer the first question, who needs to be screened. There are three different professional organizations who weight in on this topic including the American Cancer Society (ACS), the American College of Obstetrics and Gynecology (ACOG), and the US Preventative Services Task Force (USPSTF). All three recommend that we start PAP smear screenings three years after the onset of sexual activity or at the age of at the age of 21, whichever is first.
When it comes to how often women need screened the answer is a little more complex. For most women the answer is every year until you have had three negative PAPs and then every two to three years after that. For women at high risk screening may need to be more frequent. High risk means usually includes having multiple sexual partners or having a history of positive PAPs in the past.
The third question that women want to know is when can I stop getting these tests. The answer is not very well defined. The three above mentioned organizations all pose slightly different opinions. In general they say that women who meet all three criteria below NEVER need to be tested again.
1) Age 65-70
2) Have had at least three negative PAPs in the last 10 years.
3) Are not at high risk.
For this purpose not at high risk means sexually active only within a long term mutually monogamous relationship without a history of cervical or related cancers. We can also stop all PAP smears for women who have had a complete hysterectomy who do not have a history of cervical or uterine cancer.
The final word that I would like to add is the new vaccine Gardasil. This is a vaccine created to prevent HPV infection. It is available for women and girls ages nine to 26. It is a series of three shots that prevent the most common types of HPV and therefor prevent the majority of cervical cancer. It does not prevent all cervical cancer. This is heavily recommended for girls age 13-16 because to be most effective girls need to receive the vaccine before sexual activity. Currently most insurance companies in our area cover this vaccine and it is available through the Glasgow clinic so feel free to ask about it. More information about this vaccine is available at www.gardasil.com.
As always if you have any questions about any of the above material pleas schedule a visit with us at the Glasgow Clinic and we will be happy to discuss these things with you.
Wednesday, October 17, 2007
Mamograms
Sorry it's been a while since my last post. Thankfully we have not had any major local medical news that needed sharing but I have not come up with two new topics to write about. This week the value of mammogram screening and the debate about it. Within the next week or so who still needs to get a PAP smear.
In the past we have been telling women over the age of 40 to get annual mammograms to help detect breast cancer as early as possible. Therefor there are recommendations from most professional organizations such as the American Cancer Society, the American Academy of Family Physicians and many others are that all women receive annual mammograms. There are even recommendations that are newly emerging that women with certain very high risk groups receive regular breast MRIs to screen for breast cancer. But this later test is still being developed and few insurance companies will pay for it yet.
The real question that leads to debate about mammography is does it just detect cancer or does it lead to longer life. Some people argue that even if it does not chance the course of things they would rather know sooner that they have cancer while other people would say that if it makes very little difference they would rather not know. Another side is that whenever you test for a disease some people will have false positive test results. This means that they will not have the disease but the results will suggest they do. For these women there is significant psychological stress associated with the worry as well as the expense and risk of surgical procedures to test to see if they really have the cancer.
Last month American Family Physician (the journal of the American Academy of Family Physicians) had some statistics that help show the effect of mammograms. These facts are the benefits and harms if 2,000 women are offered regular mammograms for 10 years. (Note that the city limits of Glasgow only has about 900 women over the age of 40.)
1) One woman will have her life prolonged because of it and 1,999 will receive no benefit.
2) Out of those 2,000 women 10 healthy women will be treated unnecessarily for breast cancer.
3) About 200 healthy women will have the stress of additional testing because the mammogram suggested they may have breast cancer.
Right now none of the professional organizations are changing their position of mammograms and all still recommend routine mammograms. As a physician I am still offering them to patients but I try to talk with women about this when I can. I assume many women who read this may use this information in making their personal choice about getting their own mammogram done.
In the past we have been telling women over the age of 40 to get annual mammograms to help detect breast cancer as early as possible. Therefor there are recommendations from most professional organizations such as the American Cancer Society, the American Academy of Family Physicians and many others are that all women receive annual mammograms. There are even recommendations that are newly emerging that women with certain very high risk groups receive regular breast MRIs to screen for breast cancer. But this later test is still being developed and few insurance companies will pay for it yet.
The real question that leads to debate about mammography is does it just detect cancer or does it lead to longer life. Some people argue that even if it does not chance the course of things they would rather know sooner that they have cancer while other people would say that if it makes very little difference they would rather not know. Another side is that whenever you test for a disease some people will have false positive test results. This means that they will not have the disease but the results will suggest they do. For these women there is significant psychological stress associated with the worry as well as the expense and risk of surgical procedures to test to see if they really have the cancer.
Last month American Family Physician (the journal of the American Academy of Family Physicians) had some statistics that help show the effect of mammograms. These facts are the benefits and harms if 2,000 women are offered regular mammograms for 10 years. (Note that the city limits of Glasgow only has about 900 women over the age of 40.)
1) One woman will have her life prolonged because of it and 1,999 will receive no benefit.
2) Out of those 2,000 women 10 healthy women will be treated unnecessarily for breast cancer.
3) About 200 healthy women will have the stress of additional testing because the mammogram suggested they may have breast cancer.
Right now none of the professional organizations are changing their position of mammograms and all still recommend routine mammograms. As a physician I am still offering them to patients but I try to talk with women about this when I can. I assume many women who read this may use this information in making their personal choice about getting their own mammogram done.
Friday, August 24, 2007
Coughs, Colds and Ear Pain (The Common Cold)
We are now entering a season with the beginning of changing weather we are starting to see more and more colds even though it's still Summer. If you are having a common cold below is some advice that can help with the common symptoms. This is a virus that DOES NOT respond to antibiotics. In the past many doctors prescribed antibiotics for any cold "just in case." This has lead to many people getting antibiotic resistant infections even if they only have taken an antibiotic once a year or less. The common cold will start to show improvement in a couple of days with or without treatment. The only thing that we do is help with the symptoms. For everybody I recommend:
1) Rest.
2) Drink plenty of fluids.
3) Wash your hands.
Common colds are easily spread from one person to another through coughing but also through the sick person touching something that a healthy person then touches. To help protect your family and friends I recommend keeping a bottle of alcohol based hand cleaner around so that you can sanitize your hands after touching your face or blowing your nose even when a sick in not around to wash.
Sore Throats
If you have a sore throat as part of your cold symptoms there are a variety of over the counter products that can help. I personally recommend the cough drops that contain benzocaine. This is a topical anesthetic that is a sister to Novocaine used by the dentist. These drops will numb your throat to help with pain relief but be warned they will also numb your mouth. But if they help the pain most folks don't mind numbing the mouth.
Stuffed Up Noses
When noses run easily it is easy to get the junk out given that you can't really stop it from coming out. Sometimes in this very dry environment that we live in our nasal mucus gets dehydrated and we need something to loosen it up so that we can blow our nose and get it out. My two favorite products are nasal saline sprays and the Sinus Rinse Bottle. The first is a little squirt bottle that sprays a mist into your nose. The second is a bottle that you mix water in a salt packet and squirt a larger amount of water up your nose. I personally use the second for my allergy symptoms. Use these and then in a few minutes you can blow some of the mucus out and repeat if needed.
Pain In Your Ears
Often time if you have a cold or allergies pain in your ears is not an ear infection and you do not need antibiotics. Our middle ears produce a small amount of fluid all the time and we have a tube "the Eustation tube" that connects our middle ear to the back of our throat. This tube drains the fluid. If the tube gets stopped up, possibly by mucus blocking it, we get pain in our ears. If we can loosen up that mucus blocking the tube we can get rid of the pain and will not have any infection to treat. To do that you can:
1) Chew gum - This moves the muscles around the tube and helps to jar the mucus loose.
2) Drink everything through a straw - The sucking helps suck the mucus loose.
3) Eustation tube massage - You place a finger under your ear and behind your jaw in that ridge between your jaw and your neck. Then using medium force against your skin move your finger along that ridge to the center of your throat. Do this on both sides 5-6 times every few hours to help massage the mucus loose.
Muscle Aches
The best thing to help these is to take Tylenol or ibuprofen. The store brand is just as effective but cheaper. Take them according to the directions on the bottle.
Fever
We medically define a fever as any temperature of 100.3 deg F or higher as a fever. Take Tylenol or ibuprofen as above. We used to tell people to alternate them every few hours of one by itself was not working. Recent research shows this to not be effective and only leads to more side effects. Just use one and use it consistently. If this is not working let us know and we can give you advice on what to do next.
Sinus Pain/Infection
Pain in the front of the face, usually beside the nose or in the for head, is considered to be sinus pain. Many people come to see me with two days of sinus pain and feel it's a sinus infection. Sinus infections start with plugging up the nose and blocking the drainage from your sinuses. It takes at least 7-10 days to get a real sinus infection. If it's been less than that you probably just have plugged up sinuses. If you have a real infection you will need to see us for a prescription for antibiotics which we can only prescribe after seeing you. If you have sinus pain from pressure we can often relieve some or all of it by getting the mucus out of the most. Follow the directions for a stuffed up nose above. Then when the sinuses drain the pressure will be relieved and you should feel better.
Cough
Unfortunately nothing works very well for coughs. Robitussin (dextromethorphan) is the only over the counter cough suppressant but it has not been shown to be effective. It was placed on the market before the FDA was created so it was grandfathered in and has never been FDA approved. It is just as effective as an 8oz glass of water. We do have various things we sometimes recommend including codeine based cough syrups and Tessalon Pearls but they all have minimal effectiveness. Also, the cough can persist for up to a month or even a little more after the rest of your cold symptoms have resolved. So if you had a cold and the cough is sticking around don't worry it will just take time.
1) Rest.
2) Drink plenty of fluids.
3) Wash your hands.
Common colds are easily spread from one person to another through coughing but also through the sick person touching something that a healthy person then touches. To help protect your family and friends I recommend keeping a bottle of alcohol based hand cleaner around so that you can sanitize your hands after touching your face or blowing your nose even when a sick in not around to wash.
Sore Throats
If you have a sore throat as part of your cold symptoms there are a variety of over the counter products that can help. I personally recommend the cough drops that contain benzocaine. This is a topical anesthetic that is a sister to Novocaine used by the dentist. These drops will numb your throat to help with pain relief but be warned they will also numb your mouth. But if they help the pain most folks don't mind numbing the mouth.
Stuffed Up Noses
When noses run easily it is easy to get the junk out given that you can't really stop it from coming out. Sometimes in this very dry environment that we live in our nasal mucus gets dehydrated and we need something to loosen it up so that we can blow our nose and get it out. My two favorite products are nasal saline sprays and the Sinus Rinse Bottle. The first is a little squirt bottle that sprays a mist into your nose. The second is a bottle that you mix water in a salt packet and squirt a larger amount of water up your nose. I personally use the second for my allergy symptoms. Use these and then in a few minutes you can blow some of the mucus out and repeat if needed.
Pain In Your Ears
Often time if you have a cold or allergies pain in your ears is not an ear infection and you do not need antibiotics. Our middle ears produce a small amount of fluid all the time and we have a tube "the Eustation tube" that connects our middle ear to the back of our throat. This tube drains the fluid. If the tube gets stopped up, possibly by mucus blocking it, we get pain in our ears. If we can loosen up that mucus blocking the tube we can get rid of the pain and will not have any infection to treat. To do that you can:
1) Chew gum - This moves the muscles around the tube and helps to jar the mucus loose.
2) Drink everything through a straw - The sucking helps suck the mucus loose.
3) Eustation tube massage - You place a finger under your ear and behind your jaw in that ridge between your jaw and your neck. Then using medium force against your skin move your finger along that ridge to the center of your throat. Do this on both sides 5-6 times every few hours to help massage the mucus loose.
Muscle Aches
The best thing to help these is to take Tylenol or ibuprofen. The store brand is just as effective but cheaper. Take them according to the directions on the bottle.
Fever
We medically define a fever as any temperature of 100.3 deg F or higher as a fever. Take Tylenol or ibuprofen as above. We used to tell people to alternate them every few hours of one by itself was not working. Recent research shows this to not be effective and only leads to more side effects. Just use one and use it consistently. If this is not working let us know and we can give you advice on what to do next.
Sinus Pain/Infection
Pain in the front of the face, usually beside the nose or in the for head, is considered to be sinus pain. Many people come to see me with two days of sinus pain and feel it's a sinus infection. Sinus infections start with plugging up the nose and blocking the drainage from your sinuses. It takes at least 7-10 days to get a real sinus infection. If it's been less than that you probably just have plugged up sinuses. If you have a real infection you will need to see us for a prescription for antibiotics which we can only prescribe after seeing you. If you have sinus pain from pressure we can often relieve some or all of it by getting the mucus out of the most. Follow the directions for a stuffed up nose above. Then when the sinuses drain the pressure will be relieved and you should feel better.
Cough
Unfortunately nothing works very well for coughs. Robitussin (dextromethorphan) is the only over the counter cough suppressant but it has not been shown to be effective. It was placed on the market before the FDA was created so it was grandfathered in and has never been FDA approved. It is just as effective as an 8oz glass of water. We do have various things we sometimes recommend including codeine based cough syrups and Tessalon Pearls but they all have minimal effectiveness. Also, the cough can persist for up to a month or even a little more after the rest of your cold symptoms have resolved. So if you had a cold and the cough is sticking around don't worry it will just take time.
Tuesday, August 21, 2007
West Nile Virus
By now most of the community has been hearing about West Nile virus as this has become a bigger and bigger problem in this community and all of us in the clinic are seeing folks with West Nile-like symptoms.
West Nile virus is transmitted to humans from mosquitoes. Usually the mosquitoes get the virus from birds who bring it up from tropical areas as they migrate North in the Spring. It is possible to spread the virus from person to person but this will only happen with exposure to body fluids such as blood exposure, sharing needles and possibly through breast milk.
The majority of people who carry the disease never get any symptoms. Only about 1 in 5 will even feel symptoms. After contracting the virus there is an average incubation period of 2-14 days. There is a wide range of symptoms and most people will have:
1) F0ever
2) Headache
3) Malaise
4) Back pain
5) Myalgias (muscle aches)
6) Loss of appetite
These tend to last 3-10 days. Other known symptoms include eye pain, pharyngitis, nausea, vomiting, diarrhea, rash, and abdominal pain. Some of the symptoms especially fatigue and muscle aches can persist for a month or longer.
The diagnosis is made based on symptoms but we can do a blood test to confirm that diagnosis. Currently there have been so many cases of West Nile virus in this area that we do not test everybody that we think has the disease. Especially since treatment is symptomatic meaning that we just do what we can to help you feel better as your body fights the disease itself. So often we do not test because if a positive test will not help us treat you then there is no value in doing the test other than just to know for sure. The test shows us if you have had West Nile in the last six months so if you had the disease a few months prior the test will be positive even though you do not have it anymore.
Because we have no treatment to get rid of the disease faster the main treatment is Tylenol or ibuprofen. I recommend these to help with fevers and muscle aches but nothing has been proven to shorten the course of the disease. The most important thing is to avoid mosquitoes. The key ways to do that are to:
1) Use insect repellents containing DEET (for people greater than 6 months old)
2) Avoid the outdoors from dusk to dawn.
3) Wear long sleeve shirts and long pants when outdoors.
4) Drain standing water sources on your property.
On occasion the disease can spread into the brain and cause meningitis and more severe disease. In these cases we often will have to send patients to the hospital in Billings and will consider using experimental treatments. In such times the disease is much more serious and can possible lead to death. Fortunately it is not common for the disease to become this severe.
If you think you may have the virus please schedule a visit with your doctor. For more information on West Nile virus you can visit http://www.patients.uptodate.com/topic.asp?file=inf_immu/2199&title=West+Nile+virus+infection
West Nile virus is transmitted to humans from mosquitoes. Usually the mosquitoes get the virus from birds who bring it up from tropical areas as they migrate North in the Spring. It is possible to spread the virus from person to person but this will only happen with exposure to body fluids such as blood exposure, sharing needles and possibly through breast milk.
The majority of people who carry the disease never get any symptoms. Only about 1 in 5 will even feel symptoms. After contracting the virus there is an average incubation period of 2-14 days. There is a wide range of symptoms and most people will have:
1) F0ever
2) Headache
3) Malaise
4) Back pain
5) Myalgias (muscle aches)
6) Loss of appetite
These tend to last 3-10 days. Other known symptoms include eye pain, pharyngitis, nausea, vomiting, diarrhea, rash, and abdominal pain. Some of the symptoms especially fatigue and muscle aches can persist for a month or longer.
The diagnosis is made based on symptoms but we can do a blood test to confirm that diagnosis. Currently there have been so many cases of West Nile virus in this area that we do not test everybody that we think has the disease. Especially since treatment is symptomatic meaning that we just do what we can to help you feel better as your body fights the disease itself. So often we do not test because if a positive test will not help us treat you then there is no value in doing the test other than just to know for sure. The test shows us if you have had West Nile in the last six months so if you had the disease a few months prior the test will be positive even though you do not have it anymore.
Because we have no treatment to get rid of the disease faster the main treatment is Tylenol or ibuprofen. I recommend these to help with fevers and muscle aches but nothing has been proven to shorten the course of the disease. The most important thing is to avoid mosquitoes. The key ways to do that are to:
1) Use insect repellents containing DEET (for people greater than 6 months old)
2) Avoid the outdoors from dusk to dawn.
3) Wear long sleeve shirts and long pants when outdoors.
4) Drain standing water sources on your property.
On occasion the disease can spread into the brain and cause meningitis and more severe disease. In these cases we often will have to send patients to the hospital in Billings and will consider using experimental treatments. In such times the disease is much more serious and can possible lead to death. Fortunately it is not common for the disease to become this severe.
If you think you may have the virus please schedule a visit with your doctor. For more information on West Nile virus you can visit http://www.patients.uptodate.com/topic.asp?file=inf_immu/2199&title=West+Nile+virus+infection
Sunday, August 12, 2007
We are in Glasgow now
A week ago my wife, Jen, and I made it to Glasgow. We are excited to be here and I will be starting to see patients tomorrow (Monday). We had a wonderful road trip across the country to get here stopping to see family in Ohio, Nashville, St. Louis and also doing tourist things in Mark Twain's hometown, visiting pioneer stuff in Southern Nebraska and seeing national parks across Kentucky, Nebraska, South Dakota and Wyoming.
But our adventures only started as we ended our 4100 mile road trip here in Glasgow. We were not in our house more than 2.5hrs when we decided to go out and get dinner before everything closed on a Sat night. But after locking the front door we dropped our only house key and it fell through our front porch. Having no idea how to even get a locksmith at 9pm on a Sat night we decided to get dinner and ultimately had to use some of my tools from the still unlocked garage to cut a piece out of the floorboard to get it. Then the next day we had to return our rental car in Williston and were planning to take the train back to Glasgow. But we forgot that Williston is in a different time zone. Thankfully Amtrak was running 90 mins behind schedule so we were saved.
But in our first week Jen has already finished repainting our master bedroom, we have all of the large items where they need to be and are just sick of unpacking the little stuff. But we are enjoying being back and this time to stay. It was great to get out this morning to the Evangelical Church and nice to start hospital orientation this past Thursday. We do want to thank the many folks who helped us with various parts of our move and those that have been so very welcoming since we have gotten here.
But our adventures only started as we ended our 4100 mile road trip here in Glasgow. We were not in our house more than 2.5hrs when we decided to go out and get dinner before everything closed on a Sat night. But after locking the front door we dropped our only house key and it fell through our front porch. Having no idea how to even get a locksmith at 9pm on a Sat night we decided to get dinner and ultimately had to use some of my tools from the still unlocked garage to cut a piece out of the floorboard to get it. Then the next day we had to return our rental car in Williston and were planning to take the train back to Glasgow. But we forgot that Williston is in a different time zone. Thankfully Amtrak was running 90 mins behind schedule so we were saved.
But in our first week Jen has already finished repainting our master bedroom, we have all of the large items where they need to be and are just sick of unpacking the little stuff. But we are enjoying being back and this time to stay. It was great to get out this morning to the Evangelical Church and nice to start hospital orientation this past Thursday. We do want to thank the many folks who helped us with various parts of our move and those that have been so very welcoming since we have gotten here.
Friday, July 13, 2007
Doctor can you prescribe a cheaper medicine for me?
In my practice of medicine I frequently have patients asking me if there is a cheaper medicine that I can prescribe for them. We all know we have a very expensive medical system and prescription drugs are very hard for anyone to afford without insurance. It's a great blessing to have a good pharmacy benefit as part of one's health plan. This will almost always make your prescriptions less expensive but not necessarily cheap. By now most people understand that prescription plans have different "tiers" of coverage and co-pays. Usually with most plans the least expensive drugs (usually only generic medications) have a co-pay of about $5-10 per month. The higher tier drugs only get more expensive. Often co-pays for tier 3 or 4 drugs can be $40-80 per month. My usual prescribing habits are to prescribe the cheapest drug that I can to properly treat the problem but I am only aware of the cash price you would pay assuming you have no insurance.
How can I get cheaper medications? You need your doctor to prescribe medications of the lowest "tier" that will properly treat your medical needs. This sounds simple but usually is not that easy. As a physician I have patients with about 100 different prescription plans that sometimes change as frequently as every 3 months. Even through I would love to be able to help keep your medication costs as cheap as possible there is no way I can keep up with that many different plans. Sometimes I will ask patients what drug plan they have and they tell me Medicare Part D but this is little help because Montana currently has 47 different Medicare Part D plans all with different formularies (list of drugs they prefer). If you can tell me the company of your plan that may still not help because most have several different plans. For example WellCare have 7 different Medicare Part D plans in the state of Montana alone.
How can I get this mess sorted out? It's really not very hard but it does take a LITTLE bit of work on your part. At least 2 weeks before your appointment you need to call your insurance company and ask them to mail you a copy of what they will either call their "formulary" or "preferred drug list." They can look-up your specific plan and can always send that to you. You should keep this list and bring it with you to your appointments. If you can bring this list it will help your doctor do the best they can to prescribe the least expensive medications for your specific plan.
Sometimes patients need or prefer a specific drug that is not covered or covered at a higher price. Insurance companies will only cover these more expensive drugs with a "prior authorization." This requires paperwork to be filled out and filed with your insurance company before they will pay for the more expensive medication. If someone, usually the pharmacist, says the medication requires a prior authorization the best thing you can do it to call your insurance company. Usually there is a medication they cover without this prior authorization available at a cheaper co-pay. Most of the time making such a change is just fine but from time to time the substitution may not be right for you. That decision is your doctor's drug. Usually insurance companies require that you try a "covered" medication before they will approve a prior authorization for a "non-covered" medication. When you talk to your insurance company you should ask if there are alternative medications they do cover. If they don't or you have tried and failed the other medications ask them to send you a copy of the prior authorization form that will need to be completed. Complete the part of the form with your name, address and date of birth and drop the form off with your doctor to complete his/her part. If you are proactive with your insurance company in this process you will get your medication approved faster.
Sometimes the prior authorization will require that the patient try a different medication before they will approve the requested medication. Sometimes you may have already tried the other medication sometimes you have not. Often times patients have used a medication in the past which worked and they do not want to try an alternative medication first. This creates a little bit of a problem. Myself, like most doctors, prefer to prescribe a proper medication that has worked rather than one that have not yet been tried. In this case we have two alternatives. 1) I can prescribe the medication that worked but your insurance will not pay for it so you will have to pay full price. 2) We can try an appropriate substitution that they do cover. If it works great, if not we can apply for the prior authorization for the one that has worked in the past.
From time to time patients have ask if I can just sign the prior authorization stating that we have already tried the other medications. As a Christian man who strives to me a man of my word at all times I cannot do that. I will insist in being honest on any form you ask me to sign and I will be honest with any questions you ask me.
Hopefully this will help clarify some questions about the crazy process we have called prescription drug coverage. The most important part is to call your insurance company, get a copy of the "formulary" for your insurance plan, and BRING IT WITH YOU TO EACH AND EVERY APPINMTNEMT.
How can I get cheaper medications? You need your doctor to prescribe medications of the lowest "tier" that will properly treat your medical needs. This sounds simple but usually is not that easy. As a physician I have patients with about 100 different prescription plans that sometimes change as frequently as every 3 months. Even through I would love to be able to help keep your medication costs as cheap as possible there is no way I can keep up with that many different plans. Sometimes I will ask patients what drug plan they have and they tell me Medicare Part D but this is little help because Montana currently has 47 different Medicare Part D plans all with different formularies (list of drugs they prefer). If you can tell me the company of your plan that may still not help because most have several different plans. For example WellCare have 7 different Medicare Part D plans in the state of Montana alone.
How can I get this mess sorted out? It's really not very hard but it does take a LITTLE bit of work on your part. At least 2 weeks before your appointment you need to call your insurance company and ask them to mail you a copy of what they will either call their "formulary" or "preferred drug list." They can look-up your specific plan and can always send that to you. You should keep this list and bring it with you to your appointments. If you can bring this list it will help your doctor do the best they can to prescribe the least expensive medications for your specific plan.
Sometimes patients need or prefer a specific drug that is not covered or covered at a higher price. Insurance companies will only cover these more expensive drugs with a "prior authorization." This requires paperwork to be filled out and filed with your insurance company before they will pay for the more expensive medication. If someone, usually the pharmacist, says the medication requires a prior authorization the best thing you can do it to call your insurance company. Usually there is a medication they cover without this prior authorization available at a cheaper co-pay. Most of the time making such a change is just fine but from time to time the substitution may not be right for you. That decision is your doctor's drug. Usually insurance companies require that you try a "covered" medication before they will approve a prior authorization for a "non-covered" medication. When you talk to your insurance company you should ask if there are alternative medications they do cover. If they don't or you have tried and failed the other medications ask them to send you a copy of the prior authorization form that will need to be completed. Complete the part of the form with your name, address and date of birth and drop the form off with your doctor to complete his/her part. If you are proactive with your insurance company in this process you will get your medication approved faster.
Sometimes the prior authorization will require that the patient try a different medication before they will approve the requested medication. Sometimes you may have already tried the other medication sometimes you have not. Often times patients have used a medication in the past which worked and they do not want to try an alternative medication first. This creates a little bit of a problem. Myself, like most doctors, prefer to prescribe a proper medication that has worked rather than one that have not yet been tried. In this case we have two alternatives. 1) I can prescribe the medication that worked but your insurance will not pay for it so you will have to pay full price. 2) We can try an appropriate substitution that they do cover. If it works great, if not we can apply for the prior authorization for the one that has worked in the past.
From time to time patients have ask if I can just sign the prior authorization stating that we have already tried the other medications. As a Christian man who strives to me a man of my word at all times I cannot do that. I will insist in being honest on any form you ask me to sign and I will be honest with any questions you ask me.
Hopefully this will help clarify some questions about the crazy process we have called prescription drug coverage. The most important part is to call your insurance company, get a copy of the "formulary" for your insurance plan, and BRING IT WITH YOU TO EACH AND EVERY APPINMTNEMT.
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