Oct
11
2005

Have a heart!

This elderly customer looked down at the vial of pills on the counter and said, “We can’t afford that.” She put her checkbook back into her purse and said it again, “We can’t afford that.” She was stricken. Her face had turned pale. Her hands trembled slightly. She sighed deeply. “Why so much with my AARP discount?” She gave me a mean stare.

The problem was that she had lost her pensioner’s insurance when she became eligible for Medicare and we all know about Medicare and drugs for the next few months at least. Nada! “It’s not my fault.” I held my hands out, palms up. “This drug is $125.00 for 45 tablets … after your AARP discount.” “We can’t afford it,” she said one more time.

Now, this was not a legitimate life or death drug, although some psychiatrists might disagree. It was sertraline (Zoloft) and she had been taking 150 mg a day for a couple years. Had the doctor even talked to her about depression lately? “I’m going to quit all my drugs,” she said with a snap to her tongue. “We just cannot afford this kind of money.” She stared at me. This woman could be scary. She had the elegance of a big city woman and the toughness of a farm girl. “Maybe you should not just quit all your drugs,” I said, thinking of her diltiazem, atenolol and hctz. “This one, I will quit. I will not pay that kind of money for a drug.” She gave me a look. “Why are you so expensive?” I said it again. “Don’t blame me. This store is not the one making all of the big money.”

“Well who is then?”

“Can’t you guess?”

“The drug companies?”

“Bingo! Medicare will help starting next year.”

“Well, what can I do in the meantime?”

“I will tell you,” I said and I did! I told her that her AARP discount card did very well with generics, but did not do that well with brand names. I told her that there were generic drugs similar to sertraline and she would be wise to request a drug change from her doctor. She was interested now. “What drugs? Are they just as good?”

“Probably just a good, but you are the only one who can really answer that question.” I wrote the names down for her. Citalopram and beside it I wrote generic Celexa. Fluoxetine and Prozac. “Here are two good ones.” I folded the slip of paper and handed it to her. “The generic Prozac is really cheap,” I said. “I’d guess that a month’s worth would be less than $30.00 with the AARP discount.” She thanked me and assured me that she would talk to her doctor. He is a family physician. I just can’t wrap my mind around that idea that your average family doctor can competently treat depression.

Red Dragon movie

This elegant farm woman took a metaphorical club to her doctor within an hour and he had me on the phone within 90 minutes. I had made a mistake. When I make a suggestion of this type, I usually request that the patient tell the doctor that they found the information on the Internet. Doctors just don’t like pharmacists exercising our knowledge muscles. I neglected to do that and I paid the price. He was aggressive with me. “Did you tell her to change drugs?” Oh boy. I could tell from his voice that he was pissed. It was too loud and snappy. This doctor was an older physician. Some of these guys, who have been around the race track a few times, are used to pushing pharmacists around. Not me!

“Hold up,” I said, “I did not tell her to change drugs. I told her that there are alternative drugs that are much less expensive. I told her that it was up to you and I made a couple suggestions” There! Take that, big fella! I explained the price differential to the doctor. He listened carefully, but I could hear that he was not happy with me. He was breathing hard. “I told her to discuss a generic drug with you.”

“I think Zoloft is a good drug,” he said, calming down.

“Doctor,” I said very slowly, very distinctly, “She won’t take anything if you don’t write for something cheaper than Zoloft.

“You don’t like Zoloft?”

“Zoloft is a fine drug,” I said, “And when this patient had prescription insurance and the copay was only $15.00 it was fine for her. Zoloft is not the problem, doctor. The fact that 45 tablets price out at $125.00 with the AARP discount … that is the problem.” The doctor quietly asked me which generic would be the cheapest. I told him fluoxetine. He said, “She probably doesn’t even need this anymore.” He prescribed fluoxetine and hung up without saying goodbye. This incident is at the top of the iceberg. This woman was no pushover. There are thousands of people out there who never complain. They pay huge amounts of their income on very expensive medications when there may be an alternative drug that is only a fraction of the cost. How do they know? They are unsophisticated about drug prices. They do not even know how to ask: Isn’t there something cheaper that can do the job just as well? They just pay .. and pay .. and keep on paying. You know people like this.

And you are not making a hell of a lot of profit when your investment is $110.00 and the AARP discount price is $125.00. You do much better when your investment is $5.50 and the AARP price is $27.78. It looks to me that both the patient and the pharmacy come out OK. Now, I am not suggesting that pharmacists intercede willy nilly when the prescribed drug is a very expensive brand name and there is a generic alternative in the same class. There are many people who have money and there are just as many who do not! I am suggesting that we look carefully and show some compassion when buying a prescription means draining the grocery fund. I think that were can be better human beings if we take a look and actually do something about it. On the third Friday of every month, around 5:00 PM, a seventy-something woman named Crystal comes in for her monthly prescriptions. Last winter, on an icy, blustery day below zero, I took a close look at Crystal’s cold weather jacket. It was baby blue, frayed and a weight appropriate for 30 degrees, not 10 below. Her husband’s jacket was denim. I filled her prescriptions and asked the technician to ring her out. I told her that I was embarrassed. She looked at me funny and said, “Why are you embarrassed? What have you done?” “The prices,” I said, “Look at the prices.” Three prescriptions came to almost $400.00.

“Do something then.” A twenty-something idealist.

“Like what?”

She shrugged. “I dunno!”

So, I did something. I called the doctor’s office and talked with the nurse. I explained about Crystal and $400.00. I asked if the doctor had ever thought of less expensive therapy. I told her that I felt like a criminal. “These people may not get enough to eat,” I said. “The thing that gets me the most is that they never complain.” The nurse said, “I will talk with the doctor.” She did. Crystal came in with three new prescriptions the next month. Her total came to less than $120.00. The next time I saw her and her husband, they both had new winter jackets. So, if you are going to play in this game of serving people, use your head. Have a heart. And remember the old Internet trick if you don’t think you want to have your hind end chewed up by a cranky physician.

Written by Jim Plagakis in: Jp Enlarged |

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