A few minutes with Bradley…

www.Medtipster.com Source: LA Times – Author: Karen Ravn

Here’s a list of questions that you should pose before taking your medications home.

You’re tired, hungry, cranky, and you’ve been waiting in line forever. Now your pharmacist is offering to discuss your new prescription — the last thing on earth you want to do.

Do it anyway.

The warnings and descriptions on the obligatory information sheet are meant only for a general audience. Your pharmacist can offer pertinent details — and emphasize the aspects most important for you.

So don’t go home without getting answers to these questions:

What is the medication for?

In other words, make sure you get what you think you’re getting. Mistakes happen. If the medication the pharmacist prepares for you is a fertility drug and what you wanted were birth control pills, this is a prime time to find out.

What is the name of the medication?

Physicians don’t always tell patients the name of the drug they’re prescribing, and patients don’t always remember when they do. It’s not enough to know you’re taking “these big fat horrible-tasting pink things” twice a day. Your dentist, your insurance agent, the on-duty physician in an ER — all might need the actual name of your medication. You should know it.

How should you take the medication?

Some medications should be taken with food. Some should be taken only when you’re standing up. Some (especially those that are enteric-coated or designed for controlled release) can be harmful — even fatal — if they’re crushed. Only if you know the best way to take your medication can you hope to have the best results.

When should you take the medication?

Some drugs should be taken in the morning. Some should be taken at bedtime. And with some, precise timing is more crucial than with others. For example, if you’re supposed to take a pill twice a day, it would probably be OK to take it at 8 a.m. and 10 p.m. But that schedule wouldn’t be OK if you’re supposed to take a pill every 12 hours.

What is your medication supposed to do — and how soon is it supposed to do it?

If you’re coughing and sneezing and feeling achy all over, should you expect the medication to stop all this bad stuff or just some of it? If your medication is supposed to make your migraine go away, should you expect the pain to ease in five minutes? Five hours? Five days? Unless you know how — and how fast — your medication is supposed to act, you have no way to know if it’s working.

What should you do if you miss a dose?

In general, it depends on how much you miss it by, says Jeff Goad, associate professor at the USC School of Pharmacy. If you’re supposed to take a dose every eight hours and you remember half an hour late, it’s probably OK to take it right away and then resume your regular schedule with the next dose. On the other hand, if you don’t remember until half an hour before you’re due to take the next dose, you shouldn’t try to make up for the dose you missed. But medications vary, and it’s best to find out about your own specifically.

Should you keep taking the medication until it’s all gone or just until your symptoms go away?

It’s important to keep taking some medications, especially antibiotics, until you’ve used them all up, even if you feel better before that. You can take other medications only “as needed” — i.e., only when you’re experiencing the problem they’re supposed to treat. Other medications are for chronic conditions and are meant to be taken over the long term, perhaps for life.

Is it safe to stop taking the medication whenever you want?

If your medication is intended to make your broken arm hurt less and you stop taking it, your arm will probably hurt more — but probably nothing worse than that will happen. If your medication is an antibiotic intended to cure a bacterial infection and you stop taking it before you finish the full course, some bacteria will probably survive and multiply and may make you sick again. Plus you may be contributing to the rise of antibiotic resistance — since the bacteria that did survive (and multiply) will be the ones most resistant to the antibiotic.

It may be even less wise to stop taking other medications abruptly on your own. If you suddenly stop taking a medication meant to lower your blood pressure, for example, your blood pressure could spike dangerously.

What side effects should you watch out for?

In addition to the effects you want your medications to have — making your blood pressure go down or your energy level go up — drugs may have effects you’d rather they didn’t, such as making you fall asleep in a meeting with your boss. Some side effects are more common than others, and some are more serious. You need to know which are which, how you can avoid them (if possible) and what you can and should do about them if they occur. For example, the standard recommendation for medications that make you drowsy is to avoid driving or operating heavy machinery.

What interactions should you watch out for?

If you’re already taking any over-the-counter medications, herbal remedies, dietary supplements or other prescription drugs, or if you drink alcohol, your new medication might act in undesirable ways. It could be ineffective. It could be dangerous. There are ways to avoid some bad interactions, such as scheduling your doses appropriately. And there are times when the medications themselves should be avoided.

How should you store the medication?

Proper storage will ensure that your medication is as effective as possible. Usually this means in a cool, dry, dark place. Sometimes it means in the refrigerator or freezer. But for the most part it means not in the medicine cabinet in your bathroom, where conditions are often warm and moist.

Is there a way to save money on your prescription?

Physicians tend to underestimate the price of expensive drugs and overestimate the price of inexpensive ones, according to a study published in the journal PLoS Medicine in 2007. So they may not always have a very good idea of how much the drugs they prescribe are going to cost their patients. Often pharmacists can suggest changes or substitutions for prescribed medications that will save patients money.

In California, if your physician prescribes a brand-name drug and you’d rather take a less expensive generic, your pharmacist can make the substitution without consulting the prescribing physician. To change to a different drug, however, pharmacists do need the physician’s approval. Even with a hefty financial incentive, patients are sometimes reluctant to take their pharmacists’ advice.

“They think what their physicians prescribed must be better or they wouldn’t have prescribed it,” says Kathy Besinque, an associate professor at the USC School of Pharmacy who also works part-time at Patton’s Pharmacy in Santa Monica. “But really, physicians have many choices that would work.”

“Some patients assume generic drugs are less effective than brand names,” says Julie Donohue, associate professor in the graduate school of public health at the University of Pittsburgh. In fact, generics contain the same amounts of active ingredients as do the brand names they are meant to be substituted for.

“As a pharmacist myself, I would take generics,” says Ken Thai, owner of El Monte Pharmacy in El Monte.

Cost issues can affect people’s insurance coverage. “Sometimes insurance plans won’t cover new medications,” Besinque says. “They want patients to try old, less expensive ones first.”

Besides recommending less expensive medications, pharmacists can help patients save money in other ways too. For example, a pill that’s twice as strong as the one your physician prescribed usually doesn’t cost twice as much, Besinque says. So if the double-strength pill can be split in half, you can get the same amount of medication for less. Similarly, for medication you take long-term, you can often save money by buying more pills at once — e.g., 60 pills probably won’t cost twice as much as 30.

Does your pharmacy provide any special services that will make your life easier?

Some pharmacies can package your medication in daily doses, making it easier to take the right amounts. CVS Pharmacies recently began a free program to make it easier to refill prescriptions you take for chronic conditions. If you sign up for the new service, the store will simply refill any such prescriptions automatically — and then call you to let you know they’re ready.

Remember: It’s never too late, and it’s never too dumb.

If you get home and start taking your new medication and only then think of a bunch of questions about it, not to worry. “You can call your pharmacist with any question about your prescription at any time,” says Anne Burns, vice president for professional affairs for the American Pharmacists Assn. In fact, it’s just natural to have more — and possibly more important — concerns after you’ve taken the medication for a while.

In any case, “there are no bad questions,” Thai says. “The more communication people have with their physician and pharmacist, the better. When people don’t say anything, that’s when we run into problems.”

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

In a conversation I had recently with a large employer in North Carolina, I heard the following:

-generics save employers money via the $4 programs, but the majority of drugs available are brands.

Nothing could be farther from the truth. Nearly 70% of all drugs on the market have a generic equivalent. Same active ingredient, just 90% less in cost. Not drug strength, cost.
Please click here (PDF) for a generic information brochure and find information straight from the FDA.

Remember, we don’t sell the drugs…we just tell you where to find ‘em at the lowest price.

Thank you for your time and happy browsing at medtipster.com!

JK

Jason A. Klein
President
Medtipster, LLC.
email: jklein@medtipster.com
web address: www.medtipster.com

It pays to shop around – but who has time. Many pharmacies have discount generic programs and I see new programs all the time. Although the lists are similar they are not the same with differences in prices ~ drugs ~ strengths ~ and quantities. To simplify the process and same time and money visit medtipter.com. We have compiled it all for you in a simple 1-2-3 search.

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.