Past blogs have discussed various ways to save on medication costs – pharmaceutical patient assistance programs, drug discount coupons, drug discount card, etc. Let me tell you about another way you may be able to cut your medication costs.

At NeedyMeds we receive calls from people who can’t afford their medications. Most are taking just a few drugs, but a significant number are taking 10 or more drugs – sometimes 20 or more drugs. According to a recent Centers for Disease Control and Prevention report 82% of American adults take at least one medication and 29% take five or more medications.

Why are so many people taking so many medicines? In some cases the person has multiple diseases, all requiring their own medications. But sometimes not all the medicines are no longer needed. Here are a few reasons why this may occur:

Step Therapy

This is an approach used to treat many diseases. Let’s say your doctor discovers you have high blood pressure – hypertension. Your doctor would take a stepped approach to treatment. First, she would address lifestyle issues such as weight control, tobacco use, exercise, etc.

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by Rich Sagall, MD

You have an appointment to see your doctor about a health issue. It may be a new problem, a chronic issue, or an acute illness. No matter the reason, you are ready for a 10-minute visit filled with quick questions, a prescription or two, and some instructions. If you are lucky, some of your questions will be answered and you may remember a portion of what your doctor tells you.

It doesn’t have to be this way. There are steps you can take to have a more satisfying and productive visit. You may not be able to do all of these at every visit and some may make you feel a little uncomfortable, but they are worth trying.

  1. Expectations – Before scheduling an appointment, think about why you want to see the doctor and what you hope to get from the visit. For example, if you are seeing the doctor for new back pain, are you looking for an x-ray, do you want strong pain medicine or do you want reassurance it’s nothing serious? At some point you need to tell the doctor what you want. That’s not to say you will get it, but being forthright makes it easier for everyone.
  2. Take a friend or family member – Many studies have shown that patients remember little of what doctors tell them during a visit, and doctors generally overestimate how much patients remember. A second person in the room, someone who is not experiencing the stress of being a patient, can better remember what occurs and help you better follow the doctor’s instructions. Remember – this person may hear very personal and potentially embarrassing things about you.
  3. Bring a list of questions – Actually writing down what you want to ask the doctor serves many purposes and helps to make the visit more productive. First, it forces you to really think about what you want to learn and state it succinctly. Second, it helps your doctor know what you want to learn. Bring an extra copy of the questions and give it to your doctor. Third, the list provides a place for you (or your companion) to write down answers. This will help you better remember what transpired.
  4. Have a good history – Doctors depend heavily on the history of a problem to make the diagnosis. This has to come from you. Keeping a symptom diary is a great way to quantify problems. For example, if you are being seen for headaches, keep a diary for a few weeks. Enter the dates and times you have headaches, how long each headache lasts, what the headaches are like, what you are doing when the headache occurs, what helps lessen the pain and what doesn’t, etc. You get the idea. This information will help your doctor better understand what you are experiencing.
  5. Ask about tests – It’s easy to order tests and doctors tend to do it a lot. Many patients expect to have them. Before having any tests performed, you should ask, “How will the test results affect my treatment?” You’d be surprised how often the answer is it won’t. If the results won’t change anything, then a good question is why do the test?
  6. Get your test results – It’s important for you to receive a copy of every test result. Never accept the “no news is good news” response. No news may mean all is fine, but it can also mean many other things. Perhaps the doctor never received the results and didn’t know it. Perhaps the results came back and were filed without the doctor reviewing the results. Perhaps the doctor misread the results. Or perhaps the doctor saw an abnormal result, but the office staff forgot to call you. You have a legal right to demand the lab send you results, and you have a right to all results in your medical file.
  7. Ask for a copy of the doctor’s notes – You have a right to the contents of your medical record. The doctor may “own the paper”, but the information is yours. You want to make sure the doctor got it right and, perhaps more important, recording what happened correctly. Depending on your state, the doctor may be able to impose a reasonable charge, but it’s well worth it.You should understand what is recorded. If you don’t understand something, either give the doctor a call or ask at your next visit.Once something is recorded, it’s next to impossible to change or correct it. Doctors are told to never go back and change what’s in a patient’s record. It looks back if there’s ever a legal issue. However, doctors can and do include an addendum if something in the record is entered incorrectly. If you find a mistake or disagree with a statement, you should send your complaint in writing to your doctor. Ask that your statement become part of the official record.

I know some physicians will not agree with some of the above – or even all of it. When I was in practice, I followed many of these steps and encouraged my patients to bring lists, get copies of results, and become active participants in their healthcare. I encourage you to do the same.

Rich Sagall, MD, a retired family physician, is the president and founder of NeedyMeds, a national non-profit that has information on programs that help people in medical need. He is aslso the

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Last month, many of us made New Year’s resolutions and we were being deluged with advice about how to eat sensibly, how to exercise our way to fitness, and how to develop and keep healthy habits. But let’s get down to basics: how well do you follow your doctor’s advice?

Doctors will be increasingly held accountable for your overall health and wellness, and your progress towards sustained good health, under the Affordable Care Act (ACA). The ACA aims to increase the quality of care given and reduce the costs, thereby ensuring that the right care is given in the right place at the right time. More care has not proven to be better care, and reducing unnecessary and expensive screens and tests will go a long way to reducing health care costs.

But patients have a responsibility too – and that is to listen to your physician and follow their recommendations regarding nutrition, exercise and taking your medications as prescribed. “Medication adherence” or “medication compliance” are terms used to describe what patients do once they receive a prescription from their provider, including filling, and then re-filling when indicated,

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Many folks still have questions about medical homes, so we thought we would try to answer some of your questions today.

Q. How does having a medical home benefit the patient?

Having a medical home means that you have a healthcare team to take care of you, headed by your primary care physician, who will coordinate your care and ensure good communication among your team members. The concept of “Care” appears to have evolved to “caring for the whole person,” so medical needs will certainly be addressed, but the patient’s social and family situation, mental health, and spiritual and emotional needs will also be considered.

Q. How is it different from having a PCP (Primary Care Physician)?

In some ways the concept isn’t that different. Your PCP should be the one who coordinates your care. Under this model, your PCP will work with an expanded team to ensure you are getting the care you need, at the right time, in the right place. Communication between team members is highlighted, and unnecessary care, such as duplicative tests, will be reduced, resulting in reduced costs.

Q. Will having a medical home cost me extra money?

This

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