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.

Tuesday, November 25, 2008

Obama is Serious About Healthcare Reform

It certainly appears that President Elect Obama is serious about healthcare reform with his selection of former Senator Tom Daschle as his Secretary of Human and Health Services. Now the good news is that unlike his future boss, Senator Daschle recommends individual mandate, that is everyone is required to purchase health insurance. (President Elect Obama only mandated that children have coverage). Daschle's other big idea is to create a healthcare board to manage healthcare much the same way the federal reserve does for the economy.

It seems that everyone is pushing hard for healthcare reform. If it can occur for about $125 billion, relatively cheap compared to the $700 to $800 billion desired by the Treasury department, then it might occur sooner than I expected. A look over the past week revealed the following.

An excellent op-ed piece by Shannon Brownlee (author of the book “Overtreated“) and Ezekiel Emanuel (an oncologist, NIH bioethicist) dispell various myths of our dysfunctional healthcare system. In the same Washington Post, columnist David Broder feels that there is a rising hope for fixing healthcare.

Uwe E. Reinhardt is an economist at Princeton has written in the Economix section of the New York Times various articles about why the healthcare system costs so much, which also shatters widely held, but inaccurate beliefs including the issue of administrative costs.

Even NPR's Marketplace had a piece today about healthcare reform.

Of course, I neglect to mention proposals offered by Senator Kennedy or Senator Baucus. It seems like healthcare reform is THE topic to discuss, until of course Senator Clinton is formally introduced as the President Elect's Secretary of State.

I for one was certain with all of the economic uncertainty that we could have kissed healthcare reform good bye. It appears from all the news reports, op-eds, and discussions by various senior politicians that I may have underestimated their desire to see this through. Thank goodness.

I hope, however, that our leaders think carefully about how to reform our healthcare system otherwise unintended consequences will surely occur which may do far more harm than good.

Sunday, November 16, 2008

Save Money on Medical Costs - Part 2 - Travel Overseas

There have been a lot of articles over the past year about Americans traveling overseas to countries like India, Thailand, and South Africa to get elective surgeries like joint replacements, heart surgery, and plastic surgery performed. Sometimes it is at the urging of their health insurer.

The Star Tribune reported that the nation's second largest insurer, Wellpoint, will offer Wisconsin-based Serigraph Inc. and its employees the ability to go to India for elective surgeries. Serigraph will pay all of the medical costs. There will be no out of pocket expenses. Travel is paid for as well for the patient and a companion.

"Knee replacement surgery that costs between $60,000 and $70,000 in the United States can be done in India for $8,000 to $10,000, said Jill Becher, a Wellpoint spokeswoman."

The NY Times reported how South Korea has added its medical facilities and staff to be available to Americans. Shockingly a report by the consulting group Deloitte found that "750,000 Americans sought cheaper treatment abroad, a figure projected to reach 6 million by 2010".

The Wall Street Journal earlier this year cited a report by the consulting group McKinsey which suggested that overseas medical travel was posed for future growth.

What does this mean? In the future, you might get the same excellent surgical care overseas for a lot less to your pocketbook, particularly as you are becoming increasingly responsible for healthcare costs. You might even get the opportunity to sightsee as well.

The other? Doctors will begin to discover that like auto workers, their jobs can indeed be outsourced. If we as a medical profession don't see this challenge, then we may very well suffer the same fate as that of the big three automakers, Ford, GM, and Chrysler, who as we speak are looking to the government for a multibillion dollar bailout. Don't think it can happen? That's what the UAW thought as well.

Tuesday, November 11, 2008

Local ABC Channel 10 Affiliate - Part Two - Making Most of Doctor's Visit

From yesterday's ABC News 10, the host Sharon Ito and I briefly discuss some tips on how to make the most out of an office visit.

Local ABC Channel 10 affiliate Part One - Open Enrollment

Was thrilled and priviledged to be on the local ABC Channel affiliate. Thanks to the host, Sharon Ito, who asked excellent and insightful questions.




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