What A Concept!

I met with a pharmacist yesterday or a pharmacologist. It was great. When I had my annual physical with my primary care doctor in September, she was concerned about my medications and interactions.

The pharmacologist went through my entire list of medications - prescription and OTC - and asked why I was taking each one. Then she went through and looked up possible interactions with them. She gave me some advice which I found very helpful.

• Because I am on Prilosec for GERD from a sliding hiatal hernia, I need to take it in the morning, 30 minutes after my thyroid medication and then wait another 30 minutes before eating. I was taking it in the evening.
• I also need to get off prednisone for my RA.I am on a low dose but its not a good idea to stay on it long.  I will stay on it until January when my hopeful new RA medication will kick in and then I can ditch it.
• As my pain management doctor has already suggested, and I really want to do, is to reduce my Lyrica dosage or even get off it. My previous pain management doctor, if I said I had pain, he would say, 'let's increase your dose'. But he never gave me any information why or requested any scans or testing. This is why he is no longer my doctor. I meet with my pain management doctor next week. 
• I also need to change my Calcium with D to calcium citrate not calcium carbonate - something I completely blank out on when in the store.

Also, I am only on about four medications for the side effects of other medications. We had to laugh at that. 

At the end of the appointment I felt very good. A knowledgeable neutral party had looked at my meds and found that I need to be on the meds I take. I need to be careful about some interactions and see if I develop any symptoms and cut down if needed. 

I feel like I should do this every five years or so. I feel that not all doctors look at what other medications I might be on before prescribing something new.  A good experience, for once.

I Have A Problem

Since we moved, I have found I am incapable of keeping on top of my medications. I have:

• forgotten to get refills on time
• forgotten where I put my refills
• forgotten to call in refills

I have even forgotten my husband's (only) prescription and had to pay out of pocket because I didn't get the preapproval done.

This is turning into a real problem. I have been having a problem for months with increased pain in my hands and feet. Now my back has been more of a problem as well. It turns out I completely forgot to get my prescription anti-inflammatory refilled. No wonder I have been having more pain.

In our old house, I had a system. I kept all the prescription bottles on the top shelf of the closet closest to my side of our bed. Every week I sit down and refill our pill boxes. I put all the bottles in two rows on the bed, prescriptions in one row and OTC (mostly vitamins) in the other row. Then I fill my husband's pill box with his prescription, move on to the OTC we both take, and close his box and put it aside. Then I go back to my pill box, adding all my prescriptions and then the rest of the OTC items. 

If I empty a bottle or nearly empty a bottle, I put them aside until I am done and then I get a refill or replacement as needed so by the next week we have all the pills we need and we never run out.

At our new house, first we were very disorganized and there is no closet near my side of the bed. I kept all the prescription bottles in big zip lock bags on the floor in the corner. After a few weeks, I found a little book case, which doesn't hold books, to hold all my bottles. I keep everything there. Then one day a week, I put all the pill bottles on the bed, prescriptions in one row and OTC in another. I sit down and fill all the boxes as before. Sounds good? 

Well for some reason, I keep screwing up. I don't know if its because of more RA problems with my hands or that I am not focusing or something, but each week I find as I go through the week, that my pills are messed up. Sometimes I am missing one in a box, or have an extra in another. Or I find that I have missed a pill all week.

This morning I realized that perhaps one reason why my hands haven't been very good is that I have not been taking my prescription anti-inflammatory pills. I don't even have a bottle for them. I checked online and found that I haven't refilled it since late January which makes sense why I am out now. But I have no idea when I last took it. Anyway, I sent in a request for a refill and will pick it up later today. 

However, the real problem is that I need to fix my system so I stop screwing up. I need to do something because I really have to be sure I am taking everything I should. AAARRRGGGHHH!

I'm not being a good patient

I try to be a good patient. I really do. I know my health is complicated and the best I can do is be the good patient to help my medical team keep me feeling okay.

What is a good patient? They are the people who actually show up on time for doctor appointments, basically follow doctor instructions, and take their medications.

I have one area where I am falling apart - managing my prescriptions. Since we moved, my little system for remembering to refill prescriptions has fallen apart. Normally what I do is fill our pill boxes once a week. When I go through all our prescription bottles, I pull out any that need to be filled before filling our boxes the following week to make sure we do not run out.And that hasn't been working.

Several times now I do my little weekly routine and pull out the prescriptions need to be filled. Then my system fails. I then seem to ignore the empty bottles waiting to be refilled. I have no idea how I manage to do that each week.

Last week I went to refill my husband's prescription to find out that the preapproval hadn't been done because we forgot to make sure the doctor's office did. He had two switches in doctors recently which may have caused the lapse but that left me standing at the pharmacy and eventually paying full price for his meds.

This week I went to fill my pill boxes with my synthetic thyroid meds and I have none. NONE! I don't even have a refill I can get filled today. I have to call my doctor's office and beg to get my refill in today. I can go without this for one day.... and it does have an impact on how I am feeling.

I forgot another one a few weeks ago as well. I think I need a new system. In the meantime I am not a good patient.

Keep your information to yourself

Every time you sign up for another store's shopping program, where you are enticed by the discounts and special offers, you are actually giving away your information. I don't consider it as much of a problem at a clothing store or the grocery, but when its the pharmacy, that becomes another story.

CVS, Walgreens, and RiteAid offer their rewards programs and they entice you to use the card because you get special prices on products and other financial gains. When you pay for your prescriptions along with shampoo and bandaids or provide personal data points such as body weight, blood sugar, etc, it becomes another story.

"Walgreens this month launched a new smartphone app that customers can sync up wirelessly with their blood glucose and blood pressure monitors so they can feed their personal health information directly into the chain’s data system in exchange for discounts.

At CVS, you can get $5 back for every 10 prescription refills — if you waive your right to health care privacy protected under the federal health law known as HIPAA. And Rite Aid is experimenting with a service that other retailers are using to collect tons of data: special lockers that you can use to charge your cell phone for free, if you’ll give up your phone number, insurance costs, and shopping preferences."

The key words in there are "if you waive your right to health care privacy protected under the federal health law known as HIPAA". I bet you didn't even realize that you waived your HIPAA protection.

Seriously? I had no idea I was waiving my HIPAA right to privacy. Until I read this article I did not know that was going on.

"When asked how Walgreens was using all that health data, company spokeswoman Mailee Garcia said the company “does not sell personally identifiable information to third parties,” but may sell de-identified information."

Garcia said Walgreens is not currently using health data to market to the customers who provide it. But the app’s privacy policy explicitly states that Walgreens may use customer data to personalize advertising. The store can also combine data entered into the health app with personal information collected by other companies to create a more robust profile of individual customers.

The policy also gives Walgreens the right to change its privacy terms at any time and says customer data will be sold as an asset if Walgreens is acquired by another company."

So now that I know all this, I will not be swiping my card when I pay for prescriptions. I will pay for prescriptions at the pharmacy without my card and then pay for other items to get the discounts with my card. Seriously its not worth my privacy about prescriptions. If it wasn't the way to get the sale prices (and I am secretly very cheap and never pay retail unless I absolutely have to), I would ditch my card all together.

Prescription freakiness

I got this email on Friday:

"The following prescription(s) received in Order #"XXXXXXXXXXX on 11/19/2015 cannot be filled.

We can't fill one or more of your prescriptions because the drug was not available, and we have no approved alternative from your prescriber."

So helpful. I had no idea what this was for. Which medication, which doctor, which ailment.

So first I called the specialty mail order pharmacy (because some of my medications are 'special') and I can't look up those prescriptions on line. After dealing with the 'helpful' automated attended for far too long and two phone calls, I ended up with someone who told me it wasn't in that part of the specialty program. She tried to transfer me to the regular mail order department but I ended up in telephone limbo.

So I hung up and made call #3. The woman I spoke with put me on  hold to research it and then when she picked the call back up, somehow I got disconnected.

So I hung up and made call #4. The man I spoke with told me that they couldn't fill it because the prescription came in without a medication on it. Very weird.

Even weirder was that it came in from a nurse practitioner in the dermatology department on Thursday where I had an appointment with another NP.

The more I think about this, the freakier it is. How did a prescription get to a pharmacy for me when it wasn't for me? I can only think that this someone didn't realize that they were logged into my account on their computer when they went to enter a prescription for someone else.

This is not a good thing. I will call them tomorrow to discuss this. There is no excuse for this. I know people are busy but when it is dealing with patients and medications, they need to double check what they are doing and make sure they are looking at the correct patient.

Just think if you were in the OR and they were looking at someone else's chart?

The Wrong Approach to Pricing

Here is an example of the wrong approach to pricing medications. That really fancy expensive Hepatitis C drug, Sovaldi, is $1,000 per pill and $84,000 for the course of treatment and the price is justified because it saves on the cost of a liver transplant down the road and long term medical costs for the patient. WRONG IDEA!

It has now been revealed that the poor manufacturer, Gilead Sciences, which justified that price on the above reason, grossed $12.4 billion last year for the sales of Sovaldi alone. Sorry Gilead, I have absolutely no sympathy for you because of the revenue generated in the first year.

Yes, I understand the argument that the expensive drugs are justified because of the resulting reduced treatment costs for the patient in the long term and that the costs of and time to developing drugs is high and many possibilities are dumped after years of work. And that these drugs are developed for smaller and smaller potential patient markets for rarer ailments. But $12.4 billion? I think you got your money back and should cut the price significantly, maybe 1/10th of the current price.

So here is my proposal for new drug pricing: Look at your development costs of that drug that made it to market and the costs of the other drugs that eventually lead to the new drug but were dumped on the way and then price it so that your costs are recouped in five years, not one. And completely forget about the patient's long term cost savings in health costs. That is none of your business. Don't you remember HIPPA? Patient health issues are not your problem. You are providing a product that helps recover from it, just like an aspirin would relieve a headache.

Here's an example. Your current pricing method would allow restaurants to charge $3 for the tasty but bad for your juicy, fatty steak or prime rib and $80 for the  healthy side salad because of the diner's potential long term health problems from eating the steak and ensuing cholesterol and other ailment costs.

The current pricing model leads to insurance companies deciding who should receive these new  medications instead of doctors deciding what is best for their patients - which is the way medicine should be practiced.

Okay, this is all my opinion, to which I am entitled, but I really think pharma companies are doing it wrong.

Prescriptions and regulations and confusion

You might have guessed I take a few prescriptions these days. Actually I have a whole pile. Every weekend I sit down and fill our pill boxes for the week. My husband has one prescription and vitamins. I have a lot more.

I get my prescriptions from three places - the local pharmacy, the insurance company's mail order pharmacy, and the insurance company's specialty pharmacy. I got promoted to the specialty pharmacy this year for some reason. Its not that they really charge more, they just like to make my life more complicated.

What really annoys me about prescription medications are the stupid rules. The latest new rule is that I couldn't just call my pain management doctor for a refill on my break through pain meds (because the new cats hid the other bottle when they 'explored' the shelf in my closet), they had to make sure I had an upcoming appointment with the doctor. They even called me twice to make sure. (Then I explained how the cats hid my prescription which caused me to think that I had run out when I hadn't.)

The other rule that annoys me is that because of the 'opioid' crisis (which I recognize is a real and growing) problem, pharmacies want patients to have used up almost all their prescription before providing a refill. I know that pain medication use can lead to opioid abuse but not everyone.

I am picky about my prescription use. I use one of those lovely box a day pill box for years and have to take pills at three different times during the day (on an empty stomach, after eating, and before bed). If I was really good I would take some pills in the middle of the day as well but since I NEVER remember, that is not going to happen any time soon.

I also think about how often I take certain prescriptions which are prescribed 'as needed'. If I think I am taking them too often, I will take a minute to think how often I am taking them and why and if I need a doctor visit for a potential issue.

I feel I can manage my prescriptions myself and don't think I need any more rules to help me manage them. And about those prices? Well that's another story.

Cutting the last cord

What happens after all the treatment? Cancer patients are diagnosed and then get all kinds of care to make sure it doesn't come back (which is our greatest fear).

At the end of treatment, all of a sudden this constant care by all kinds of medical people to check you over and reassure you that it hasn't come back comes to a screeching halt. At this point, the doctors all say come back in 3, 6, or 12 months and we will check again. And the patient says 'whhhaaattt? But what if it comes back? Who will know?'

This is the most frequent time for patients to wig out and require emotional support from a support group or therapist to make sure they don't go off the deep end. It is a very stressful time. You are alone with the little thoughts in the middle of the night - what if it comes back?

With breast cancer, its a little different. You get surgery and chemotherapy. Medical personnel is all around to be aware of a single sneeze. Then some get radiation as well where you are seen daily for weeks on end. At the end of this time most go on to hormonal therapy - Tamoxifen, Femara, Aromasin, or the other one who's name I can't remember right now. That lasts for five to ten years. And then finally you are on your own and you see your oncologist maybe once a year.

I went through this a long time ago when I had thyroid cancer. At the end of about six months of doctor appointments I was left to cope on my own. And I can tell you in some ways it really sucked big time. And left me with some strong emotional issues that took a long time to recover from.

When I was diagnosed with breast cancer, I told myself I was not going to let cancer suck any happiness out of my life and went to support groups before my first surgery. Then I got a therapist at the end of radiation as well. But I was still on hormonal medication - 2 years of Tamoxifen and then Femara.

Yesterday I went to see my oncologist and she said it was time for me to end Femara - that last little pill to help prevent it from coming back. She said she had mentioned this at my visit last year but since I can't remember last week, never mind last year, I had no memory of this. 

Basically while there is lots of data on the benefits of staying on Tamoxifen for ten years there is no research now to prove there is any benefit to staying on Femara or other aromatase inhibitors for longer than five years. There are ongoing studies on this but no results yet. This research will take years because they are following women after five years of Femara.

My oncologist brought up the joint pain issues I have. She said that one of the side effects of Femara was joint pain. I couldn't tell you if I am experiencing this or not. All I can remember is after chemo, I went on Tamoxifen and started feeling better because I wasn't in chemo any more. Then after two years of Tamoxifen I went on Femara and again started feeling better again because the side effects of Tamoxifen can be pretty bad. But I have no idea how I would feel not being on Femara because pre-breast cancer I was a much healthier person.

So now the plan is I am off Femara for now through Labor Day. That should give enough time for it to leave my system and see if I have any fewer pains or if I get too worried. My oncologist brought up the stress of recurrence fears, not me. She said at that time, I can always decide to go back on it if I want.

I am happy to take one less pill each day. But it has been the last stand against recurrence. So now I have to learn to live without the benefits of anything to prevent recurrence. For now, I think I can live with this. But if my mind starts playing tricks on me with this recurrence crap, I may wimp out and decide to go back on it.

Pay for performance

I like this idea. It would mean that if the expensive prescription medications did not work, you (and your insurance company) would get your money back. I really like this idea.

I can't tell you how many medication bottles I have in my closet for things that either didn't work or gave me an allergic reaction. But I still had to pay for them.

But in the face of these attention grabbing high prices for new medications, the insurance companies want to be able to get their money back.

"Among those leading the drive for new pricing is Express Scripts, a company that bargains with drug makers on behalf of employers and insurers. It is advancing a plan that would offer different reimbursement rates for drugs that treat more than one type of cancer based on how long the drugs extend lives. Insurers, including Harvard Pilgrim Health Care and Blue Cross Blue Shield of Massachusetts, are examining that payment arrangement and others, such as rebates to patients and insurance plans in cases where drugs aren’t effective.

The new payment criteria are likely to emerge slowly and vary widely based on types of medications and payers, which include insurance companies and some government plans such as Medicaid. But proponents agree they need to rein in prices of specialty drugs, which can run up to tens of thousands or hundreds of thousands of dollars a year."

"US health insurers, which have long talked about paying for a drug’s value, now see an opening. It remains difficult to quantify value for thousands of medications ranging from acute care drugs like antibiotics to chronic disease treatments for conditions like diabetes and high blood pressure. But advances in information technology are making it easier for doctors, hospitals, and insurers to keep track of patients and how they respond to prescribed therapies."

"“It’s a huge change for the pharma companies,” Sherman said. “They realize their prior argument — that they can’t be held responsible for the [patient] outcome — doesn’t work any more and they have to get with the program.”"

Think of it this way, you buy a pair of pants and like the way they look. But you get home and decide they don't fit right. You take them back and get a refund. Now you get a prescription and try it and you are stuck with it, even if it doesn't work. That part needs to change.

The looming precipice

There is a looming precipice here for the biotech industry. Its the pricing precipice. There is an article on this in today's Boston Globe. The three main issues for the industry are:

1. There are no biosimilars (think generics) to help bring down the costs. And the biotech companies have been fighting them with  multiple lawsuits to prevent them.
2. Salaries have caught up with pharmaceutical companies.
3. Prices have started to make headlines.

'Tony Dodek, associate chief medical officer at Blue Cross Blue Shield of Massachusetts, says high-priced “specialty drugs” represent just 1 percent of the prescriptions handed to Blue Cross’ members, but 25 percent of the insurer’s spending on drugs, a share that is rising rapidly. “That’s not sustainable,” Dodek says.'

'While we are seeing a profusion of breakthrough treatments..., the price is often determined by asking, “What’s the highest price I can charge and get away with,” said Alison Taunton-Rigby, a former biotech executive who serves on several corporate and nonprofit boards. Speaking at a recent industry conference, Taunton-Rigby said, “It’s an attitude we need to talk about. I think we actually have a black mark against us as an industry.”'

'Many in the industry will complain that they need these high prices to justify the millions of dollars burned bringing a new drug to market, and attract new investment to cultivate the next generation of drugs. But the industry needs to consider ways to trade short-term “profit maximization” for its own long-term vibrancy.'

The biotech industry has been producing drugs which save lives but also cost more than the average house for a course of treatment. With a house, you can get a mortgage with a prescription, you and your insurance company will go broke. An example of the new Hepatitis C drug which costs $84,000 for a 7 month course which cures 90% of the patients. That's cheap compared to a $175,000 liver transplant.

A new drug to come out later this year for Cystic Fibrosis will cost over $300,000 per year. That would be the same as buying a new house every year. Who can afford that?

Pharmacies decide when you can get your prescriptions

Yesterday I went to the pharmacy to pick up two refills for me and get my husband's prescription filled. No such luck. I got one prescription refilled. The other one is too soon according to the pharmacist. And my husband's was also too soon. As I was actually speaking with the pharmacist who I have spoken with several times in the past (because I am a frequent flyer at the local pharmacy), I decided to ask more questions.

I found out that most national chain pharmacies make their own rules as to when you can pick up a prescription. At Walgreen's, where I was, and at CVS, you can only pick up some prescriptions, of medications subject to abuse, the day before or the day they are needed. Rite Aid, I was told, allow you to pick it up two days prior. You can't pick them up sooner. And if you are going on vacation and want to pick up a prescription early you need to show a plane ticket or something. This isn't a law or anything this is a rule the chains have developed.

Really? How non-customer focused! This is a huge example of poor customer service. From the store's point of view, the customer has to come back to the store for each prescription (unless they can be perfectly timed to be picked up together) and potentially purchase other items.

But from the customer's point of view, with poor health probably, multiple store visits at the company's convenience are not so good. I have options here. I can switch my prescriptions to mail order where they are more lenient on prescription dates as they have to allow for shipping time.

I completely understand the issue of substance abuse, fake prescriptions and all that. But this is a bit too strict in my eyes. I can understand if its a new prescription or a new customer should be made to wait. An existing customer who gets their prescriptions filled regularly should not have to deal with this.

I have always believed that it was the insurance companies and laws that were the basis for determining when you could pick up your prescription. Not stupid company policies. Sorry I am not a fan of these. Maybe its time to write to the corporate offices to complain.

Price increases? Really?

Aha, so I found another dirty little secret of the pharma industry. When sales volume goes down, they raise prices to make up the difference.

"The 9.9% hike in Enbrel's list price pushed through by Amgen on May 1 illustrates once more how biotech and drug companies profit by raising the cost of their older medicines to offset falling prescription volume. Enbrel doesn't work any better for rheumatoid arthritis patients today than the drug did when first approved in 1989 -- but its does cost a lot more.

The same Enbrel with a list price of $10,000 per year in 1989 now costs almost $42,000 per year. Inflation only accounts for about one-third of Enbrel's price increase.

Amgen relies on regular price hikes to maintain sales growth of its older drugs, which are being used by fewer patients. ...Enbrel sales grew 13% to just over $1.1 billion in the first quarter, but only because Amgen raised the price of the drug 19% to offset a 2% drop in prescription volume.
The most recent uptick in Enbrel's list price follows two similar price increases last November (7.9%) and June (6.9%).... 

Abbvie also raised the price of Humira, a competing rheumatoid arthritis drug, by 9.9% on April 1. (And Amgen's hike matched that exactly one month later. Interesting.) Humira's patents in the U.S. and Europe expire in 2016 and 2018, respectively, paving the way for the approval and commercial launch of cheaper "biosimilar" versions.

The roll-out of less expensive but equally effective treatments for rheumatoid arthritis patients is likely to put a dent in revenue generated by Amgen and Abbvie. But until that day of reckoning comes, the prices of Enbrel and Humira will surely march higher."

How sneaky. I should try that. As I cut back my work hours because of my health, I should demand more per hour to compensate. I am sure my boss would like that. Not!

A shell filled beach on Sanibel, near our condo.

A cheap little pill

I have often blogged about the high prices of medications because I think some of them are just astronomical and are partly priced based on what their manufacturers think is something along the line of the value to patients. If a pill costs $100,000 and will make you get a break from your ailment, would you be willing to pay it (with help from your insurance company)?

But to see for example of how price impacts patient's compliance with the doctor's advice, look at this study. Basically it found that household net worth had a large impact on women continuing their post breast cancer hormonal therapy - aromatase inhibitors.

Its a relatively cheap little pill. I was on tamoxifen and now on letrozole (femara) which costs me a few dollars (less than $5) for a 90 day supply now that a generic is available. It has shown to greatly reduce recurrence rates for breast cancer. Previous studies suggested a five year course after treatment ends but now new studies show that ten years or longer are even better. Thus, I will be on it for a few more years, at least.

Some parts of me are amazed that a cheap little pill could be helping prevent a cancer recurrence. Other parts of me think of it as just a cheap little pill and maybe I could stop it so I had one less pill to take each day. My oncologist doesn't want me to be off it for more than a couple days at any time. If there is a gap in my supply because I forgot a refill, she will be happy to do what she can to make sure I have a supply.

So back to the study. Apparently 10% of women stop taking their aromatase inhibitors each year and 24% never start them or stop them overall. Even though they can reduce your risk of recurrence by 50%. So there is  a potentially big impact for those who take them. The study showed that lower net worth households (this is all assets - house, stocks, cars, etc - less debt (mortgage, loans, credit cards) have a higher rate of discontinuing their hormonal therapy. It was not influenced by income or race as usually reviewed.

If patients have enough issues in complying with their doctor's advice for an inexpensive little pill that has high impact, what about the affordability of these higher priced medications?

Managing prescriptions and insurers

Every Saturday afternoon I have a job. I refill both our prescription boxes for the week. It often slides to Sunday morning. But it takes a good 20 minutes or so and I have to keep the cat away or he walks over it all and dumps everything out. I pull out all the pill bottles and count them and organize them. 1 prescription, 2 vitamins, and 2 OTC meds for my husband. 2 cancer prescriptions, 1 fibromyalgia prescription, 2 RA prescriptions, 1 back pain prescription, 5 vitamins for me, and 1 OTC med, I think, for me. But I could be wrong. It takes a little organization as well.

This week I screwed up. Big time.

First of all I should have refilled my husband's prescription last week. I didn't. Today is Sunday. He took his pills today and we have exactly one day's more of pills. That gets us through tomorrow. Then we have a secret back up set of pills for him and that's it.

Tomorrow is a holiday and I will try to get a refill for him. But I don't know if his doctor will be available and can fill it - usually they want 48 hours. And it has been requalified by the hospital (probably by a law) that a prescription can only be written by the prescriber and not an on-call doctor and must be picked up in person, not mailed or faxed. So it may be Tuesday. And it has to be picked up at the office where his doctor moved to which is 15 miles away.

Damn.

Then I went to refill two of my prescriptions at the local pharmacy. They can only fill one because the other one now requires preauthorization which needs to be done annually. Damn, again. But I have a two week cushion left on that one so it should be okay.

Finally, I went to refill two prescriptions by mail order. Both are expired. Damn, again, again. But I also have a cushion on them because they are mail order.

So tomorrow I will call around and get all refilled. What a pain!

I spend a lot of time managing prescriptions. A few weeks I saw my rheumatologist and she tweaked some of my prescriptions and sent in new ones. One of the medications can no longer be filled at the local pharmacy for about $1/month but has been reclassified as a 'specialty' medication and has to be filled by the mail order specialty pharmacy. Each time it is filled, it will cost $35/month. After 3 months, I can switch to a 90 day supply for the price of $80 for three months.

Right now the insurers and my back pain are winning. And the blizzard - we woke up to another 15"+ of winter wonderland outside.

Never share prescriptions

This is a prime example of why to never share prescription medications. A young woman in California took an antibiotic from a friend and ended up with a horrible reaction and is hospitalized with an allergic reaction that took a very nasty turn.

Two comments to note: First of all the friend had an antibiotic left from a previous cold. She should have taken all the antibiotic and not stopped it. Second of all, NEVER SHARE PRESCRIPTIONS!

I have seen and heard this countless times. A friend gets her Ativan from her sister. She also gets some pain meds from her. I think she should just go to the doctor and get her own prescriptions but she doesn't want to take the time. I have been on retreats where one woman wanted to see if she could get an Ativan from anyone, complete strangers met that afternoon. Someone offered one to her. Really? Bring your own.

Another additional problem with the habit of sharing prescriptions is making sure they do not end up being abused by others.

I can tell you that I have had allergic reactions to new prescriptions. Every time I get a new drug now, I read the allergic reaction list on what to look for. What happened to the woman in California is unfortunate and a warning to others not to share.

Right to try laws

I have mixed emotions on right to try laws. These are laws which hope to circumvent federal laws and get drug companies go make new and experimental drugs available to patients who are looking for that one last chance, when all other possibilities have been exhausted.

Colorado, Missouri, and Louisiana have already passed these laws due to strong social media programs.With right to try, the patient needs a prescription or recommendation from their doctor for th e new drug that they take straight to the drug company.

It sounds like a good idea for patients who are looking for that last chance. There are patients who have benefitted from these last chances but here are the issues:

• the FDA already has a program for compassionate use where patients have to fill out s lengthy form that usually gets approved.
• Drug companies who provide drugs under state law and ignore federal law run the risk of making the federal government a bit unhappy,

While streamlining the federal governments approval process may not be a bad idea, circumventing the federal government might not be the smartest idea. I think I would want to lobby my federal, not state, legislators to recognize that patients are smarter these days.

Prescription drug commercials

Doesn't anyone wonder why we have to put up with the warnings on drug ads and commercials? The FDA is considering shortening these lovely side effect lists that we all like to make fun of.

I have a better idea. Why don't they ban direct to consumer advertising for prescription medication. I found out that it is illegal everywhere except the US and New Zealand. So why can't they just get rid of it?

"Those who dislike the practice, according to ProCon.org, might argue that the money spent on advertising is passed on to consumers. Ads cause people to pick medicines based on the effectiveness of the ad rather than the effectiveness of the medication, and ads cause patients to desire and request medications from their doctors that may be unnecessary, thus leading to an over-medicated and unhealthy society. Those in favor of these ads argue that consumers should be informed about medical conditions and therapies, and the ads even help to de-stigmatize certain conditions. The ads might even be said to help demystify medical treatment and doctors themselves, who should not be seen in such a powerful, almost godly light."

The argument that some people will pick medicines based on the effectivness of the ad not the medication is valid. But I will agree that the ads might help de-stigmatize certain medical conditions. Who remembers being embarrassed in elementary school when your mother would write a note that said you had 'diarrhea' and had to stay home? Now we can blog about cancer and not piss off most normal people (a note to the British blogger).

Lets just say they spend $5 billion (with a b, not an m) in direct to consumer advertising each year. What if they applied that tiny chunk of change to lowering their prices? They also spend another $20 billion promoting their products in other ways - this would be maybe (and I am speculating here) conferences, speaker fees, packaging, market research, and more.That $20 billion could also help reduce medication costs.

This is all my opinion but I don't think those ads have ever helped much - just confuse everyone with their side effect lists. And allow the creative ones among us to create endless spoofs. If they are becoming a joke in popular culture, that might give you an idea of how well the ads really work.

Doctor's Orders

Do you heed your doctor's orders? (Do you floss more because your dentist asks?) Two-thirds of Americans do not take their prescriptions medications as prescribed. That would mean that most of us are screw ups.

Yes there can be the issue of cost of the medications but aside from that it is sheer laziness or ignorance. I'm  not sure why.

The problem with not taking your medications as requested can result in life risking events - uncontrolled asthma or heart condition can result in an expensive Emergency Room visit or hospital stay. Even if its covered by insurance that adds costs to the medical system. And its 125,000 extra deaths each year.

I do my best to take my medications as requested by doctors. They make it damn complicated.

This is what I do:
Take this one daily, except Monday's when you should take 1/2 a pill.
Take these two pills weekly, 12 hours after your methotrexate injection.
Take this pill in the morning at least an hour after you take you first pill.
Take an extra pain pill at bedtime or at least 3 hours after taking evening pills.
And if I take all my evening pills at the same time I get a stomach ache so I need to split them up and take my vitamins later.

Every week there tends to be a little pile of vitamins that I missed at one time or another.... So I'm not perfect either.

Mouth sores and other medical adventures

I never really had a problem with mouth sores. Until chemo that is. For those of you who are uninitiated, think canker sores.Ouch

During chemo, I was lucky enough to end up with mouth sores fairly frequently for the first few months, until my protocol changed to Taxol. My oncologist prescribed what is known as ''Magic Mouthwash" which his mixed by the pharmacist. Until that point, I never realized that the pharmacist at Walgreens or CVS would mix things to order in this day and age. I was under the mis-assumption that everything came out of a prepared bottle and was just resorted and relabeled.

But I digress. During chemo, I enjoyed Magic Mouthwash to solve my mouth sore issues. So why is she blogging today about life six and 1/2 years ago you ask? Because I am now on Methotrexate for my RA and it causes mouth sores. I have two on the tip of my tongue. Ouch.

So Wednesday afternoon I went to see my rheumatologist. She prescribed Magic Mouthwash for my then one mouth sore. I asked what is in it and found out they usually prescribe a combination which contains Benadryl, lidocaine (pain), Maalox (coating properties), and an anti-fungal. I said I am allergic to Benadryl. She had to find a combination without Benadryl.

She said she would have it, and another new prescription, called into the hospital pharmacy so she could communicate directly with the pharmacist. I had another test and then stood in line at the pharmacy to find out that my prescriptions had not even made it to the pharmacy yet, never mind be filled. They called the doctor's office and found out that the nurses had a question on her notes and had to wait until she was done with her next patient. I said fine, please have them sent to m y local pharmacy and I'll pick them up later.

Two hours later, I called the pharmacy and they did not have the prescription yet, only another one which I decided to pick up in the morning. But it was too late to call my rheumatologist back to find out about the missing 'magic'. And my mouth sore still hurt.

Yesterday morning I was back on the phone with the doctor's office. It was a computer glitch the prescription was in the system but the doctor hadn't signed off on it for some reason so it could be sent to the pharmacy. A second mouth sore started to emerge as well.

At 2pm I called the pharmacy to see if the magic was ready. No it wasn't. I called the doctor back and the secretary said it had been sent to the pharmacy but my insurance company wouldn't cover it because it contained Maalox which is available over the counter so it had been punted back over to my doctor for another revision and signature.

At 4pm I called the pharmacy again and found out they had just received the prescription and wanted an HOUR to fill it as they had to mix it. I went home and got comfy because my feet hurt and my tongue hurt, with its second mouth sore. They called 30 minutes later to say it was ready. Grr.

I got back in my outdoor clothes to go back to the pharmacy and picked it up. The second I walked in the door, I grabbed a spoon and swished it around my mouth. Relief finally!

After a lot of red tape, my tongue stopped hurting... That was just one day in my life as a patient. And my tongue still hurts when I eat anything.

Prescription Dollars Wasted By 913 Doctors

This kind of thing really pisses ticks me off. Everyone in the country is trying to do their part to help reduce medical spending. Most people really do try. Patients get generics, are taking better care of themselves, doctors think about costs when suggesting treatments, hospitals are trying to manage their costs in many ways, insurance companies are managing and lowering their overhead costs.

Then we have a bunch of 913 loser doctors who prescribed name brand drugs without allowing for substitution by generic. Now I realize that some people need the name brand drugs  because the generics are not the same for them. But some investigative journalism was done and found out about these losers.

A small portion of doctors nationwide is costing American taxpayers big time because of their tendency to prescribe name-brand medications through Medicare even when generics are available, according to an analysis by ProPublica, a nonprofit organization producing "investigative journalism in the public interest."

The biggest offenders are 913 practitioners who, thanks to disproportionately prescribing name-brand drugs, cost taxpayers an extra $300 million in 2011, say ProPublica's Charles Ornstein, Tracy Weber and Jennifer LaFleur. Each of these doctors wrote at least 5,000 prescriptions that year, according to the report.

$300 million a year is not chump change. And these doctors had ties to pharmaceutical manufacturers. So if you multiply 913 doctors times 5000 prescriptions (pause while I find a calculator because my brain is not that smart 5*3=15, carry the 1, 5*1 is 5 plus 1 equals 6, 5*9=45) equals 4,565,000 prescriptions each year. 

And think of that year after year. $300 million and 4.5 million prescriptions times kickbacks which send them on fancy vacations and secret accounts in the Caymans at the expense of the American taxpayer through Medicare. Now you understand while I call them losers.

I am glad about this piece of investigative reporting. I hope those losers now get fined, lose their medical licenses and have to start paying back. I also hope Medicare fixes the loophole.