Sunday, October 27, 2024

How to pay less for your medication

Most adults take prescription medications, either on a regular basis for a chronic condition or on occasion for acute problems. If you live in the U.S., you should be aware that you are going to pay 2-3 times what residents of most other countries pay for the same medication.

If you are wealthy and have great health insurance, you can stop reading and worry about something else. If you are like most of us, you may occasionally be faced with “sticker shock” at the pharmacy counter.

As health care costs and the cost of health insurance keep rising, one of the ways employers and insurers have reacted is by raising the co-pays that even those with health insurance are required to pay.

Many older adults and those with less-generous insurance plans have responded by skipping medication – simply not taking a prescribed remedy or trying to stretch it out by taking it less often than prescribed. This can result in seriously bad health outcomes.

How can you cut your prescription costs without risking your health? There are multiple ways.

First, be open with your doctor. Tell them if cost is a concern, as there are many things that the doctor can control. If you are prescribed a brand-name drug, ask if the same or a similar drug is available in a generic. There is usually a huge difference in price.

If the need for a medication is borderline, see if lifestyle changes can substitute for a prescription. For such conditions as mild high blood pressure or borderline diabetes, exercise and dietary changes may avoid the need for a drug. Obviously only do this with careful monitoring and discussion with your doctor.

If only an expensive brand-name drug is needed for your condition and you have commercial insurance, ask about drug-company provided co-payment cards, which your doctor will either have or can request. These are typically used as enticements to get doctors to prescribe new expensive drugs and are a last resort when the drug truly is best for you. (Note these are not allowed under Medicare, only commercial plans.)

Shop around! There will often be dramatic differences in price between different pharmacies. Local non-chain pharmacies (if you can find one!) and the big-box stores will usually have lower prices than CVS or Walgreens for identical products.

Use GoodRx for coupons. A large majority of prescription drugs are available this way.

Check out the Cost Plus Drugs on-line pharmacy, which sells many generic drugs at substantially lower prices than you will find at retail pharmacies.

Before reaching for your insurance card, ask the pharmacy what the cash price is. For many common generic medicines, this may be less than the co-pay you will be charged if you use your insurance.

If you are in Medicare with Part D coverage or in a Medicare Advantage plan, be careful to scrutinize the plan’s formulary every open enrollment period. Just because your medications are covered this year does NOT guarantee they will be next year.

Don’t be passive and accept sticker shock. A little work can pay big dividends.



Prescription for Bankruptcy. Buy the book on Amazon

Sunday, October 20, 2024

Read the fine print

My father had many aphorisms. One which I use frequently is “Figures don’t lie, but liars figure.” The drug companies are masters at using numbers to mislead; they will make big print statements that are accurate but convey a message not consistent with real value.

You might see “Our new cancer drug lets patients live 50% longer than current treatments.” Only in the small print do you find out that patients receiving their very expensive and very toxic drug live 3 months while those on a much cheaper drug with minimal side effects live 2 months. People might still opt to use the new drug, but they should do so with a real sense of what it does.

The food factory companies have come up with their own way of misleading with true statements. These have been termed “halo effects.” Adding some healthy-sounding ingredients has been found to sway most customers into believing the product is good for you.

Protein is currently in vogue, so many packaged foods are labelled High Protein. What you do not realize without looking more closely at the packet is that the “high protein energy bar” they are peddling is an expensive candy bar loaded with fat and sugar with some extra peanuts or soy added.

Another favorite is Vitamin Enriched. Adding even large doses of vitamins to highly processed foods still leave them as highly processed foods and not healthy.

“No Artificial Sweeteners” sounds good, right? But sugars of all sorts are “natural” while large doses are hardly healthy.

Organic or non-GMO may be inherently better than otherwise, but if the underlying food is not healthy, the fact that it is organic does not change that fact. Fatty meat is not healthy even if the animal was raised on an organic farm.

These tricks are used widely, but particularly for impulse purchases such as snacks.

Don’t let agribusiness manipulate your subconscious! Think and read before you buy.


Prescription for Bankruptcy. Buy the book on Amazon

Sunday, October 13, 2024

What to do when your insurance company won't pay

We are living in an era, in the U.S., when the insurance company often overrides your doctors’ decisions. Less often with traditional Medicare but more often with commercial health insurance and Medicare Advantage plans, you may find that a test or procedure your physician ordered is refused payment by your insurer and you are stuck with a huge bill.

A report found that in 2020, 18% of in-network claims were denied by commercial insurers. Don’t passively accept this decision! The denial letter is just the start of the process, not the end.

It has been shown that many of these denials are arbitrary and unjustified. A well-know example is the physician reviewer who admitted in court that he never even read the documentation but rubber-stamped nurse reviewers’ denials.

The denial may be based on a wrong diagnosis code being submitted or a failure of the insurer to consider changing medical standards.

While very few people challenge these denials, almost half the appeals succeed.

What can you do?

First, carefully read the denial letter to try to understand the reason coverage was denied. Yes, the prose is dense, but the insurer must explain its reason for denial.

You may find that before they pay for C, they want you to try A and B first and you have already tried A and B without getting any benefit. You may find that the test or procedure is not considered appropriate for condition X and you have condition Y.

If they have the facts correct and simply refuse payment, you will need to get the ordering doctor involved. They will have to write a letter explaining why they chose to do the test or procedure.

Your first point of contact should be the insurance company’s customer service line. Be sure to get the name of the person with whom you speak. For simple mistakes, they may be able to reverse the denial, but don’t count on it.

Your next step is to write a letter or an email requesting the denial be reversed and saying why. The process should be outlined in the denial letter. If not, it will be on the insurer’s website.

If the response is to still deny the claim, persist. Request an appeal. Indicate in your request that you plan to file a complaint with your state’s consumer protection bureau if the claim is still denied (and do so!).

Finally, outside help is available through the Patient Advocate Foundation and similar organizations.

Illegitimi non carborundum! Don’t let the bastards grind you down!


Prescription for Bankruptcy. Buy the book on Amazon

Saturday, October 5, 2024

Sleep problems and how to fix them

To sleep…perchance to dream

Insomnia, dissatisfaction with sleep quality or duration, is a common problem. Some 10% of Americans have chronic insomnia and another 15-20% have occasional insomnia.

While scientists do not fully understand why we (and virtually all living animals) need to sleep, lack of sleep contributes to many problems, including interpersonal, school and work functioning, depression and hypertension.

There are specific medical problems that may underlie insomnia. Restless legs and obstructive sleep apnea lead this list and will respond to specific therapies. Your bed partner is more likely to pick up on these than are you, and a session in the sleep lab will usually confirm the diagnosis.

Shift workers are particularly at risk for insomnia and the problem may not go away until you get a regular work schedule.

Most have insomnia as its own problem. Insomnia may have started at the time of a life stress or due to jet lag and then persists.

What can you do? There are many ‘common sense’ hints that may be all you need. Try to go to bed and get up at the same time every day, including weekends. Be sure your bedroom is dark and cool. Exercise early in the day, not in the evening. Do not work right up until bedtime; allow yourself time to decompress by relaxing reading or music. Do not eat within 2 hours of bedtime.

If these do not work, what next?

Sleeping pills, whether over-the-counter or prescription, are fine for short-term use but are not that effective when used chronically, and the more effective prescription drugs can have side effects.

Older individuals are at particular risk of falls, morning confusion and even dementia with chronic use of benzodiazepines (Valium, Ativan etc.). The so-called “Z drugs,” (Zolpidem, zaleplon and eszopiclone) have black-box warnings because of sleepwalking and other potentially risky sleep behaviors.

Sedating antihistamines like Benadryl have limited efficacy and cause dry mouth and daytime sedation. They are also potentially causes of dementia if used chronically.

Most experts strongly recommend cognitive behavioral therapy (CBTI) before medication. The success rate is high and there are no side effects. The problem is the lack of trained therapists and the cost.

An alternative is a web-based or phone app. These have been found to be almost as effective as in-person coaching. Two web-based programs that have good studies behind them are no longer available. I was able to download Shuteye, which promises a full year of coaching for $30 which appears good, but I have not fully tested it. Similar, and free, is Insomnia Coach, developed by the VA.

Also recommended, for technophobes, is the book Quiet Your Mind and Get to Sleep.

Should CBTI not work, young adults whose problem is falling asleep can try melatonin or a short-acting benzo. If sleep maintenance is the problem, low-dose doxepin or similar drugs are useful. Also approved for this use are three orexin receptor antagonists (ask your doctor!), which have fewer side-effects than benzos but are quite expensive. If you are going to use medication, be sure to also practice good “sleep hygiene” as noted above.

Sweet dreams.


Prescription for Bankruptcy. Buy the book on Amazon