Thursday, November 27, 2008

Book Review - How to Save on Prescription Drugs

Fairly good. Mostly accurate.

Dr. Edward Jardini, a family physician focuses on one aspect of healthcare costs, specifically prescription drugs. His 20 cost-saving methods break down into the following groups.

(1) eliminate nonessential prescriptions – stop medications no longer needed because the problem resolved, medications no longer worked, medications never worked, medications were never needed.

(2) think beyond the prescription bottle – treat whatever ails you with lifestyle changes (lose weight, exercise, eat healthier, quit smoking), nondrug treatments, prevent disease naturally.

(3) avoid overpriced me-too drugs – don’t asked for advertised drugs, don’t take free drug samples (it’s how drug companies get you hooked on their most expensive drugs), insist on generic drugs, insist on cheaper drugs in the same medication class, for a particular medical problem (i.e. allergies), get the medication class that is cheapest (antihistamines like benadryl are cheaper than nasal prescription steroids).

(4) be smart – split tablets, be prescribed the right dosage or amount (some medications cost the same for the 20 mg and 40 mg so if you take two 20 mg pills per day, it would be cheaper to tae a 40 mg pill), ask to see if another dosage exists, don’t treat one medication’s side effects with another, shop around, get it for free (take free samples that you absolutely need and enough for the short period of time you need it or if you’ll get insurance to cover the cost), and finally,

(5) use pill programs – programs from drug companies that give discounts (PPA Rx 1-888-4PPA-NOW or www.pparx.org), through the federal government like the VA, TRICARE, or state through Medicaid / Medi-Cal, and possibly Medicare Part D).

Overall the advice is good and we should always ask the doctor for generic medications that are effective for the problem at hand and not get fooled by slick advertising. An excellent free website listing drugs that are the best value for the conditions they treat is by Consumer Reports and found at www.crbestbuydrugs.org. I was surprised he didn’t include this important unbiased source. He also didn’t talk about how Wal-mart and other retailers offer $4 prescription medication and for 90 days, it would cost $10. Another cost saver.

At times, the advice given was misleading or overly optimistic. On page 3, he notes that the generic cholesterol medication lovastatin 10 mg tablet is 58% cheaper than the brand name Lipitor 10 mg pill which is true. What he failed to mention is that the generic drug is only ¼ as potent which means you’d need four times as many pills to get the same cholesterol lowering effect! For the area on think beyond the prescription bottle, yes lifestyle changes would be great, but for the vast majority of people they’ve tried dieting, exercising, and they ultimately need medications to address their medical condition. Telling us what we should do but despite our best intentions are unable to do so really isn’t a cost-saving method per se. Dr. Jardini focuses on one aspect of healthcare costs, specifically prescription drugs. His 20 cost-saving methods break down into the following groups.

(1) eliminate nonessential prescriptions - stop medications no longer needed because the problem resolved, medications no longer worked, medications never worked, medications were never needed.

(2) think beyond the prescription bottle - treat whatever ails you with lifestyle changes (lose weight, exercise, eat healthier, quit smoking), nondrug treatments, prevent disease naturally.

(3) avoid overpriced me-too drugs - don't asked for advertised drugs, don't take free drug samples (it's how drug companies get you hooked on their most expensive drugs), insist on generic drugs, insist on cheaper drugs in the same medication class, for a particular medical problem (i.e. allergies) get the medication class that is cheapest (antihistamines like benadryl are cheaper than nasal prescription steroids).

(4) be smart - split tablets, be prescribed the right dosage or amount (some medications cost the same for the 20 mg and 40 mg so if you take two 20 mg pills per day, it would be cheaper to take a 40 mg pill), ask to see if another dosage exists, don't treat one medication's side effects with another, shop around, get it for free (take free samples that you absolutely need and enough for the short period of time you need it or if you'll get insurance to cover the cost), and finally,

(5) use pill programs - programs from drug companies that give discounts (PPA Rx 1-888-4PPA-NOW or www.pparx.org), through the federal government like the VA, TRICARE, or state through Medicaid / Medi-Cal, and possibly Medicare Part D.

Overall the advice is good and we should always ask the doctor for generic medications that are effective for the problem at hand and not get fooled by slick advertising. An excellent free website listing drugs that are the best value for the conditions they treat is by Consumer Reports and found at www.crbestbuydrugs.org. I was surprised he didn't include this important unbiased source. He also didn't talk about how Wal-mart and other retailers offer $4 prescription medication and for 90 days, it would cost $10. Another cost saver.

At times, the advice given was misleading or overly optimistic. On page 3, he notes that the generic cholesterol medication lovastatin 10 mg tablet is 58% cheaper than the brand name Lipitor 10 mg pill which is true. What he failed to mention is that the generic drug is only ¼ as potent which means you'd need four times as many pills to get the same cholesterol lowering effect! For the area on think beyond the prescription bottle, yes lifestyle changes would be great, but for the vast majority of people they've tried dieting, exercising, and they ultimately need medications to address their medical condition. Telling us what we should do but despite our best intentions are unable to do so really isn't a cost-saving method per se. Also asking doctors about whether the evidence from various research studies on heart disease or osteoporosis means that medications can be stopped may be out of the reach of most patients. Often seeing a doctor is intimidating. Asking a doctor about not only the latest research but also then asking to stop the medication because of it may seem too high of a hurdle for some to do.

Nevertheless, he advocates that readers communicate with their doctors about prescription drugs and not to stop without checking in with their doctor. An excellent companion book which covers how to talk to doctors, offers the truth about herbals, dietary supplements, body scans, and also has a section on prescription drugs that would complement this book well is Stay Healthy, Live Longer, Spend Wisely – Making Intelligent Choices in America’s Healthcare System.

1 comment:

Edward Jardini MD said...

Dear Dr. Liu,

I was amused by your review of my book How to Save on Prescription Drugs on your web log and in the Amazon customer review section. However, your statement that the book is “misleading” is troublesome.

Your example is the price comparison between lovastatin and Lipitor from page 3. While I agree with you that Lipitor is the more potent drug, you have missed the point. I am not comparing their efficacy, but only their relative prices as an initial choice of therapy. The lovastatin may very well achieve treatment goals at an affordable price for a patient with limited means. The point is to show how bringing up cost at the time new treatment is recommended could steer the doctor toward a more economical choice.

According to a recent Kaiser Family Foundation survey, 41% of Americans have trouble paying for prescription drugs, and 29% admit to never filling a prescription simply due to cost. I think you would agree that lovastatin at any dose works better than a prescription of Lipitor that is never filled because the patient cannot afford it.

Anyway, a three month supply of the 40mg dose of lovastatin is still 58% cheaper than the 10mg dose of Lipitor ($99 versus $238 for a 90-day supply as priced on drugstore.com.). You have made it sound as if one would incur quadruple the cost to be adequately treated with lovastatin. That is what is misleading!

Bringing up cost might also result in the doctor prescribing simvastatin or pravastatin, which are generically available and much cheaper than Lipitor. (One can purchase a 90-day supply of the 20mg dose of pravastatin on drugstore.com for less than $45—81% cheaper.) Am I truly misleading my readers?

The manuscript of my book was reviewed and critiqued by Dr. Allan S. Brett, the editor-in-chief of Journal Watch. He is arguably the single most qualified person in the country to assess the accuracy of such a book. All suggestions and corrections of Dr. Brett were implemented prior to publication. In addition, there are over one hundred fifty references to recent articles from major medical journals backing the content of my book. So your heading on the Amazon review of “mostly accurate” is quite inaccurate itself (and a little insulting), and I respectfully request that you amend it.

As a fellow author I’m sure you understand how having favorable and accurate reviews can greatly influence sales. We are both trying to use the printed word to expand our influence beyond an office-based practice for the good of patients everywhere, and there is room for both our publications. People who buy these books buy many titles. There is no need to discredit my work in order to promote your own. They are not mutually exclusive, but are complementary.

I wish you luck in your career and ask that you use caution and discretion in reviewing another’s work.

E. Jardini MD

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