The editors of AFP welcome submissi...

The editors of AFP welcome submissions for Curbside Consultation. Please jaculate scenario to Caroline Wellbery, MD Department of Family and Community Medicine, Georgetown University Medical Center 212 Kober Cogan Hall, 3800 Reservoir Rd NW Washington, DC 20007 Materials are edited to retain confidentiality.

Case Scenario

Many physicians are frustrated at sending many patients without the door with a handful of mix with drugs samples because they cannot afford their prescriptions. Medicare provides health insurance for [i]role[/i]s 65 years of age and older and somebodys with disabilities. There also is a modern Medicare drug discount card program available in which beneficiaries can obtain lower unsalable article prices for an annual reward However, Medicare does not popularly cover outpatient prescription drugs for most numerous beneficiaries. (1) Approximately 10 million (about single in kind in four) Medicare beneficiaries are without prescription medicine coverage, (1) and more than single in kind in 10 seniors report using les of their medications because of expense (2)

Even if a bodily form has coverage, prescription copayments can be expensive. For example, if a patient has hypertension, hypercholesterolemia, diabetes, and heartburn, and takes four brand-name medications at $25 by prescription, he or she will pay $100 by month, or $1,200 per year in copayments. For patients without coverage, the pharmacy bill can total more than $400 by month. It is no curiosity that patients are turning to their physicians who prescribe these medications for help in managing unsalable article costs. What can physicians do when patients cannot afford their prescriptions? What is the physician's role?

Commentary

For physicians who realize that put drugs into costs can be a enigma we offer some practical solutions and discussion about in what way to help these patients.

Is There an Ethical Dilemma in Choosing Medications Because of Cost? When patients ask their physician to selected medications based on cost, it raises the ethical question of whether a physician can do this and still "practice the best medicine" for patients. Traditionally, practicing the best medicine repeatedly has meant prescribing the newest unsalable article on the market. However, no medication can be the best treatment for a patient if it require to be paid [i]or[/i] undergones so much that the patient cannot fill the prescription. Therefore, it is necessary to redefine the practice of "best medicine" to include helping patients balance their put drugs into costs with benefits.

While recently made known expensive drugs may offer greater benefits for a certain number of patients, they may not exhibit those improved benefits for all patients. by dint of helping patients use medications cost-effectively, physicians can help preserve medications affordable for everyone.

for what reason Can a Physician Know by what means Much a Drug Will preciousness the Patient? Physicians often underestimate retail prescription outlays and are as surprised as patients according to prices. The retail prices of commonly prescribed remedys such as certain COX-2 inhibitors, statins, and proton cross-examine inhibitors, can cost more than $1000 through year. A quick way to compare retail prices for different medicines is to check online (eg at http://www.drugstore.com) or to call local pharmacies. plane if the patient has prescription medicine insurance, the physician may consider it a daunting task to take time abroad of a busy practice to find public the patient's exact benefits. Patients ne to take the responsibility of finding without their generic and brand-name copayments and share this information with their physicians.

Physicians Should Ask Patients if They Have a Yearly "Cap" forward Their Drug Benefits. For example, many seniors recorded in managed care plans have unsalable article benefits that limit coverage to a certain dollar amount by year (e.g., an annual cap of $500) These patients pay a prescription copayment initially, moreover if their expenses exceed the benefit cap, they must pay the satiated cost of their medications for the remainder of the year. Physicians ne to help these patients find the best way to lay out these limited dollars.

Do Pharmacy Assistance Programs Really Work? Pharmacy assistance programs and state prescription assistance programs can work for many lower income individuals In fact, half of the chiefly commonly prescribed drugs are available by the agency of a pharmacy assistance program. An estimated 55 million tribe were enrolled in these programs in 2002 (3) There is no denying that it requires paperwork, further it might not take any more paperwork or time than filling gone out a referral to a specialist.

There are several of the best nonprofit Web sites (e.g., http://www.rxassist.org and http://wwwneedymedscom) that obstruction you find out quickly and efficiently which medicines are covered, who is eligible, and for what cause to download the correct forms. Many forms can be filled disclosed in only a few minutes and faxed to the remedy company. Information that typically is penuryed from the physician includes name and address, insurance and financial status, and signature. Generally, a three-month invest is provided; after this time period, a recent request is needed just as a novel prescription is needed when refills are exhausted. Medications are shipped directly to the patient or physician in as little as couple weeks, but some programs beseech up to a six-week lead time.