P is for Pharmacies & Pharmacists – #AtoZ Challenge 2018
The topic of today’s discussion is how to get the most out of your pharmacy and the pharmacist. It is my experience that many people simply fill a medication and begin to take it as ordered without ever consulting with the pharmacist regarding potential side effects or interactions with other medications they may be on. This is a dangerous and potentially even deadly practice that should be avoided at all costs.
In the case of a person who has multiple illnesses, whether chronic or acute, there are often times where you may be on multiple medications. The pharmacist is a very knowledgeable and extremely well-trained resource which many people fail to take advantage of. They spend more time than probably any other practitioner in the healthcare professions studying, learning, and keeping up with potential interactions between medications, the different systems of your body, and the way that even some foods will interact with your medications.
While it should go without saying that it is preferable and highly recommended that you use one single pharmacy, and even one location of that pharmacy if it is a chain, to promote the best continuity of care and avoid interactions and side effects, it is a challenge for many to do this. You may be asking yourself why anybody would use multiple pharmacies other than for improper reasons. I’m about to explain it to you very simply.
Let’s assume that you are among the many without prescription drug insurance coverage and that all your medications must be paid for strictly out of the cash you may have on hand. Given the often high and varying costs of prescriptions among competing chains or even independent pharmacies, you could easily find yourself paying substantially more for a prescription from one pharmacy to the next.
I have, on many occasions, found huge differences in cost for a particular prescription medication between pharmacies even when the manufacturer, dosage, and quantity were absolutely identical. This often meant that to take one medication I would have to forego taking another purely due to cost. As a result, I have found myself having to literally shop for the best prices on medications in order to at least try to be able to take the medications I may need.
While I advocate against this method of managing your prescription medications in most cases for those with prescription insurance the simple truth is that without doing this I would not be able to afford my medications, and at times I still can’t. If I don’t shop around I often have to choose which medications I will fill and which ones I will do without. Worse yet, maybe I can scrape enough together on my limited income to get my medications but that means I have no money left for the rest of the month for other necessities such as food.
Thanks to the appearance of free services such as GoodRx I can, quite literally, sit in my physician’s office during my appointment and check to see if I will be able to afford the medication they wish to order for me. When something has shown to be prohibitively expensive we can immediately discuss possible alternatives. This leads to less confusion when trying to communicate with them later by phone to get another drug ordered, and aids in making sure that the treatment plan will actually be feasible for the patient to participate in and avoids what physicians call medication noncompliance.
While a 10 to 12 dollar difference in a medication may not sound huge, it can be insurmountable if you have multiple prescriptions to fill and that seemingly small difference adds up exponentially. Let’s be clear though, I do not advocate going out of your way to a pharmacy just to save five dollars. Whenever possible it is best to stick with one pharmacy and pharmacist team to manage your medications. However, if it comes down to a choice of affording your medications or not getting them, or sure you can get your medications but you then can’t afford to purchase food, then you do what you have to do.
I currently use three different pharmacies myself as just one medication can differ between 30 to 50 dollars for a one-month supply between the pharmacies, and even this is not standard. The price for the same prescription can vary from month to month. I have started asking my health care providers for paper prescriptions whenever possible so I can go where it is the most financially feasible as opposed to them sending things electronically to my preferred pharmacy as listed in my chart. Granted some offices really dislike doing this, but when I explain it to them they typically acquiesce, though sometimes reluctantly.
To prevent unwanted interactions, side effects, or even death from taking different medications it is imperative that if you find yourself having to shop for the best price that you present each pharmacy and pharmacist with a complete and accurate list of your medications. I will include a form with this post in which you can both give them a copy, as well as keep one for yourself with known side effects or other pertinent information for each medication you take.
Without giving the pharmacist this information you are essentially playing roulette with your own health and yes even your life. Without this information how can the pharmacist be expected to know that you are taking a drug that could potentially have a serious side effect, or worse yet lead to a fatal interaction between drugs? Maybe a combination of drugs affect your liver or kidneys when taken together, but are seemingly harmless when not combined with other drugs. How our bodies process, metabolize and excrete each medication varies depending upon a variety of factors not the least of which is other medications we are also taking.
Print out the form, fill it in and keep one with you so you have it whenever you go to the pharmacy. In this way, a little preplanning can prevent a lot of trouble down the road because you forgot to tell them one of the medications you were on. If you get a new medication, don’t be afraid to ask to speak to the pharmacist about it before you leave the pharmacy. They are very well trained and most are extremely eager and willing to share that knowledge with you to provide you with the best experience possible in your own health choices.
Show them your medication list that you have prepared. Specifically, ask about any interactions that may occur between drugs or even food interactions. Ask them about side effects either from a new drug or maybe an effect such as drowsiness compounded by multiple medications. Pharmacologic intervention can often be a good thing but as with anything is healthcare is not without risks and we must be sure to evaluate those risks so that we as both patients and consumers can make informed decisions about our own healthcare.
More than once I’ve had a pharmacist who I trusted implicitly have a discussion with me that while the medication I was there to get filled might work well for most people, that due to another medication I was on it might be a better choice to go with a different drug to avoid exacerbating side effects. I can tell you that almost each and every single time that this has happened, I would ask them to call and ask the doctor while I waited. (We all know a doctor will talk to the pharmacist more readily and quickly than the patient in most scenarios.)
When the pharmacist explained her reasoning the physician almost always concurs. A few times I’ve had the physician even honestly admit that they weren’t aware of that potential negative consequence, and thank the pharmacist for suggesting another drug that would be safer or more effective with fewer side effects. This is just another example of how open communication can work in the best interest of both the practitioners and the patients.
Do you have tricks to help manage your medications? Do you use a regular pharmacist or at least keep a complete, accurate list of your medications to consult with the pharmacist? We’d love to hear from you so let us know in the comments!
PS – GoodRx is a lifesaver to me and many people I know without prescription insurance coverage, and best of all it’s free! Note that to my knowledge it cannot be combined with any form of prescription coverage whatsoever. Also, the form for tracking your medications for the pharmacy can be found here: Pharmacy Medication List – Tupeak Hope