The Official Medtipster Blog

■ Don’t use providers that aren’t in your network. Most plans have lowered how much they will pay for doctors or facilities not in your network, while some won’t pay for out-of-network providers at all.

■ Review how prescriptions are reimbursed under your coverage. Many plans are now offering reimbursement based on a percentage of the retail cost of a drug, which can add up quickly. If you pay a percentage instead of a co-pay, compare prices at different pharmacies.

■ Prepare for a doctor visit ahead of time if you anticipate a prescription, diagnosis or treatment plan. You should have your benefits summary with you as well as your drug formulary to know how much you’ll pay for a prescription before you leave the office. You can also pull up prices at local facilities on your tablet or phone at www.medtipster.com to discuss choices with your doctor.

■ Read your benefits summary carefully to know what’s in your plan, and what isn’t.

■ Shop for the lowest priced facility for diagnostic tests. Hospital-based services are often priced higher than independent facilities.

www.Medtipster.com Source:  Office of National Drug Control Policy, via The White House, 4/25/2012, White House Study Release

People who abuse painkillers get their start with pills they received (or took) from friends or relatives according to a study published by Office of National Drug Control Policy.

The ONDCP findings from the Substance Abuse and Mental Health Service Administration’s NSDUH covered the periods 2009 and 2010. The study focused on the growing problem of addiction to prescription opiod (narcotic) drugs. These pills include oxycodone, hydrocodone and others.

Study findings

• 71% of persons used pain relievers in some fashion from friends and family:
  • 55% of persons who used pain relievers non-medically obtained the pain relievers from a friend or relative for free
  • 11% bought them from a friend or relative, and
  • 5% got them from a friend or relative without asking
• The more frequently prescription pain relievers are used, the more likely these pain relievers were obtained from doctors or purchased, rather than by getting them for free.
• 17% were prescribed by one or more doctors, and
• 9% were purchased from a friend, dealer, or the Internet.

The pattern was different for long-term abusers.

• 41% got pills through friends or relatives, and
• 26% through doctors.

What should my blood sugar be??

You and your doctor will determine what your target blood sugar levels should be after some testing and properly answered questions about your diet, exercise, and any medications you are on.

For people without Diabetes, according to many doctors and experts, blood sugar levels should be:

Between 70 and 120 mg/ dL

For people with Type 2 Diabetes:

• Fasting (not eating for a suggested period of time): up to 130 mg/dL
• After most meals: less than 200 mg/dL
  

Why should I check my blood sugar?

Learning how to monitor your own blood sugar levels with a meter is a good thing to do. It helps you see how food, physical activity, and medicine affect your blood sugar levels. The readings can help you manage your Type 2 Diabetes day by day or even hour by hour. Make sure you keep a record of your results for your doctor to review.

How do I test my own blood sugar?

Consult with your doctor or pharmacist for proper technique when using the machine. Be sure you know how to test your blood sugar levels the correct way. There are many different meters out there, choose the one that makes most sense to you and recommended by either your doctor or pharmacist.

How often should I check my blood sugar levels?

Self blood sugar tests are usually done before meals, after meals, and/or at bedtime. Ask your doctor when and how often you need to check your blood sugar. Your doctor may recommend more or less than average readings.

If I test my own blood sugar levels, do I still need the A1C test?

Yes. An A1C is a 3 month average of your blood sugar levels. Therefore you cannot cheat on this test. The results of both the blood sugar tests that you do yourself and A1C tests help you and your doctor get a complete picture of your control of Type 2 Diabetes.

Visit www.medtipster.com to find a pharmacy/mini clinic in your neighborhood offering low cost Hemoglobin A1C tests!

Genetic testing could be the answer to lowering adverse side effects and ineffective prescriptions from doctor to patient.

You can get a personalized license plate. You can buy a personalized birthday card. You can even buy a personalized fortune cookie. And soon you could be buying a personalized prescription?

It happens a lot, a doctor prescribes a medication to a patient, and it simply doesn’t work. Then it’s back to the doctor, another prescription, in what feels like a “trial and error” situation. This could all soon be a thing of the past.

Genetic testing can determine a person’s reaction to a particular prescription medication. How some drugs cause adverse side effects in one group of people, and work wonders in other people, is strictly a matter of a gene group difference found between the two groups of people. Imagine if doctors knew before writing a prescription exactly how the medication would affect the patient. Problem gone!

Individualized treatment of prescription medication sounds complicated. However, the big drug companies support this theory that personalized medications would cut costs and ineffective prescriptions dispensing. What are your thoughts? If a simple genetic test would clarify which prescriptions will work best for you, would you take the test?

Source: Boston.com http://www.boston.com/news/science/articles/2010/01/25/personalized_prescription/?page=1

Source: U.S. Department of Labor, 2/2010

The Department of Labor published FAQs to supplement FAQs published in July 2008, and to provide further guidance in response to additional questions from plans and service providers on the requirements for reporting service provider fees and other compensation on the Schedule C of the 2009 Form 5500 Annual Return/Report of Employee Benefit Plan. Inquiries regarding these supplemental FAQs may be directed to EBSA’s Office of Regulations and Interpretations at 202.693.8523.

The new FAQs — numbers 26 and 27 — note that PBMs perform many services for which they are compensated, including services as a third-party administrator, claims processor, and developer of the plan’s formulary and pharmacy network. The FAQs make clear that fees for these services would be reportable as direct compensation on Schedule C.

Q26: Pharmacy Benefit Managers (PBMs) provide services to plans and are compensated for these services in various ways. How should this compensation be reported?

PBMs often act as third party administrators for ERISA plan prescription drug programs and perform many activities to manage their clients’ prescription drug insurance coverage. They are generally engaged to be responsible for processing and paying prescription drug claims. They can also be engaged to develop and maintain the plan’s formulary and assemble networks of retail pharmacies that a plan sponsor’s members can use to fill prescriptions. PBMs receive fees for these services that are reportable compensation for Schedule C purposes. For example, dispensing fees charged by the PBM for each prescription filled by its mail-order pharmacy, specialty pharmacy, or a pharmacy that is a member of the PBM’s retail network and paid with plan assets would be reportable as direct compensation. Likewise, administrative fees paid with plan assets, whether or not reflected as part of the dispensing fee, would be reportable direct compensation on the Schedule C. Payments by the plan or payments by the plan sponsor that are reimbursed by the plan for ancillary administrative services such as recordkeeping, data management and information reporting, formulary management, participant health desk service, benefit education, utilization review, claims adjudication, participant communications, reporting services, website services, prior authorization, clinical programs, pharmacy audits, and other services would also be reportable direct compensation.

Q27: PBMs may receive rebates or discounts from the pharmaceutical manufacturers based on the amount of drugs a PBM purchases or other factors. Do such rebates and discounts need to be reported as indirect compensation on Schedule C?

Because formulary listings will affect a drug’s sales, pharmaceutical manufacturers compete to ensure that their products are included on PBM formularies. For example, PBMs often negotiate discounts and rebates with drug manufacturers based on the drugs bought and sold by PBMs or dispensed under ERISA plans administered by a PBM. These discounts and rebates go under various names, for example, “formulary payments” to obtain formulary status and “market-share payments” to encourage PBMs to dispense particular drugs. The Department is currently considering the extent to which PBM discount and rebate revenue attributable to a PBM’s business with ERISA plans may properly be classified as compensation related to services provided to the plans. Thus, in the absence of further guidance from the Department, discount and rebate revenue received by PBMs from pharmaceutical companies generally do not need to be treated as reportable indirect compensation for Schedule C purposes, even if the discount or rebate may be based in part of the quantity of drugs dispensed under ERISA plans administered by the PBM. If, however, the plan and the PBM agree that such rebates or discounts (or earnings on rebates and discounts held by the PBM) would be used to compensate the PBM for managing the plan’s prescription drug coverage, dispensing prescriptions or other administrative and ancillary services, that revenue would be reportable indirect compensation notwithstanding that the funds were derived from rebates or discounts.

More information to follow via our blog at www.medtipster.com

Medtipster.com, the user friendly prescription drugs search engine for consumers, has launched a doctor specific search site to help locate generic drugs for patients.

When you visit your doctor, many times you leave with a prescription that needs to be filled immediately. Doctors care about their patients’ health – yet now they can show more care and concern by helping patients locate the cheapest prescriptions available.

“We want doctors to inform their patients how they can save on drugs, and support the use of generic drugs, at the same time,” says Jason Klein, President of Medtipster.com. Medtipster.com is the online search engine for consumers to locate cheap prescription drugs at a pharmacy near them, with most drugs available on a $4 generic program.

The newly launched Doctor Medtipster has functions separate from the consumer site. While the consumer site will promote immunization, health screenings and mini-clinic searches, the doctor site will not. “We know that doctors have a client base, and certainly don’t want to promote these types of services to those who are not looking for them,” Klein says. “We want doctors to use our site and understand that we want the best options for the patients, just as they do.”

This is the main reason Medtipster.com launched in early 2009, to give consumers a choice when it comes to healthcare. With the average brand name prescription cost of $93.00, the website’s focus is choosing generic drugs. The new “doctor appealing” website will help doctors encourage their patients to save on prescriptions. With nearly all doctor’s offices using internet and innovative technology, doctors can now find where their patients’ newly written prescriptions are available as generic drugs before the patient leaves the office. While generic drugs are the bioequivalent of a brand name drug, doctors often encourage patients to buy generic drugs when possible.

Medtipster.com is quickly earning its reputation for helping consumers find the cheapest prescriptions available right in their neighborhood. It plans to earn the same reputation with doctors, giving them the tool they need to help their patients save on prescriptions before they leave the doctor’s office.

Tylar Masters

How to get the most out of your doctor’s appointment

We all know the drill… you show up for your doctor’s appointment, you wait X amount of minutes for the nurse to call your name, weigh in (always the fun part, I know), then step in to a room where you’re instructed to sit on an oversized paper gum wrapper and wait. Twenty minutes later, the doctor steps in to ask you about your symptoms, and in many cases, the doctor seems as though they are in a hurry. If you want to make sure you get the most from your doctor during that time, be sure you’re asking the right questions!

Make a list of items you want to discuss, brief your doctor on these items so the two of you can determine which items need to be addressed right away and which items can wait until your next appointment. Keeping a journal or notebook dedicated to health concerns, prescription questions, diet, exercise, etc. is a good idea.

Never be afraid to talk to your doctor about what’s really going on. As my own mother (who is a nurse) once told me, there really isn’t much a doctor hasn’t seen or experienced with another patient. If you’re not sure why your doctor is asking you a specific question, ask! Your doctor is there to help you, no matter how busy they seem to be.

Talk to the nurse at the nurse station before you go into your examination room. Just as the doctors are there to help you, so are their nurses. In many cases, the nurses can answer questions you have about your health. If for any reason they cannot answer a question for you, they will simply tell you that you will need to ask the doctor. Once you leave the examination room, feel free to ask any follow up questions with the nurse. Many times, the nurse will check with the doctor about your question before you leave to clear up any outstanding issues you thought of after leaving the examination room.

Remember that getting the most from your doctor’s time is all about communication. It’s also important to be honest when communicating with your doctor! Doctors go through all those years of education and hard work because they are passionate about healing and helping, YOU!

For more information and a specific list of common questions for your doctor, visit the Agency for Healthcare Research and Quality (AHRQ) website’s “Questions Are the Answer Series” at www.ahrq.gov/questionsaretheanswer/.

Tylar Masters
Manager of Marketing and Communications
Medtipster, LLC.
web address: www.medtipster.com

Tylar Masters

We’ve all asked that famous Halloween question, “trick or treat?” What we expect is some foil wrapped deliciousness, some sort of taste explosion in our mouths, not a $32.00 deduction from our bank account (otherwise known as “trick” in my opinion!)

I visited my doctor the week before Halloween back in 2007 because I had a terrible cough, sore throat, chest congestion and a fever. The doctor told me I had bronchitis, and wrote a prescription. On my way out, I grabbed a mini-snickers from the plastic orange pumpkin, thank goodness, because that was the only real “treat” I got out of the deal.

I told my doctor I didn’t have prescription insurance. He advised that he could call in my prescription to the pharmacy that was directly across the street from his practice and they would have the drug available for just $4.00. I was so relieved to hear this news! I drove over to the pharmacy, waited about 25 minutes for my order to be filled, while managing to steer clear of the temptation of wandering around the store buying several things I really didn’t need.

The pharmacist called my name, and I went to the counter to pay for my prescription. “Your total is $36.00,” she said. I replied, “oh, umm, I’m sure there’s a mix up, you see, my doctor told me this would be just $4.00 here.” You know, because doctors are always right, right? “No, this is the generic and it’s $36.00,” she repeated that price as if I was automatically supposed to know my total. I had no clue, and apparently neither did my doctor, that this particular pharmacy had no such drug at that price, nor any others for that matter.

You see, each pharmacy really does have its own list of generic prescriptions available on the $4.00 program. But who knows that? I sure didn’t. And my doctor clearly did not. I didn’t know there was even a way to know which pharmacies carried which drugs on their $4.00 programs. It can be very confusing to the average consumer, which is why Medtipster.com exists.

Stick with David Copperfield for your tricks and Medtipster.com for your treats!

Just for fun, the origination of Halloween’s famous question: http://tinyurl.com/yhe77e8

Tylar Masters
Manager of Marketing and Communications
Medtipster, LLC.
email: tmasters@medtipster.com
web address: www.medtipster.com

I used to love those small sweet bites at least until July 2007 came around and my parents were in the donut hole. My parents called – when I arrived a pile of EOBS (explanation of benefits) were given to me. They were in the DONUT HOLE and what was I going to do about it, wanting to be a teenager again and respond “Not My Problem”, it was my problem because I chose the Medicare Part D provider. Ok, so it was my problem. My parents had a fighting chance their daughter was PharmaSue we just did not know that then. I worked with their physician to change medications to drugs on the Four Dollar type lists and they have not been in the donut hole since.

Since I cannot come to each of your homes and work with your doctors personally and I certainly do not want you to be one of the many millions of Medicare Part D beneficiaries that go without medication – I became involved with medtipster so that we can bring this information to you too! Tell your family and friends it is for all of us.