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.

Monday, July 2, 2007

The Value of the Healthy Lifestyle After Age 45

Some people question if there is value in starting to life a healthy lifestyle later in life. According to a study being published this month by the American Journal of Medicine the answer is yes.

The researchers started with a group of people age 45-64, encouraged them to adopt four lifestyle habits and then followed them for four years. The lifestyle habits were:
1) Not smoking
2) Exercising at least 2.5 hours per week.
3) Eating at least 5 servings of fruits or vegetables daily.
4) Keeping their weight down to a BMI of 18.5-30. (Click here to calculate your Body Mass Index, BMI.)

In their study only 1,000 of 16,000 people started to follow all four habits. But after starting to follow all four habits that group had a much lower rate of both death from heart attacks/strokes (35% lower) and from any cause of death (40% lower).

So even if you are not in your 20's or 30's anymore it's not to late to see benefits from healthier living. If you are concerned about your health and these things call us at the Glasgow clinic at (406) 228-3400 to talk with one of us about what you can do to improve your overall health.