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Why Prescriptions Cost So Much and What You Can Do About It


cartoon
A couple of weeks ago the news was filled with stories about Martin Shkreli the CEO of Turing Pharmaceuticals, a relatively small drug manufacturer. Some media branded him with this headline world's biggest a holebecause he raised the price for one pill of Daraprim, a 62 year old drug,
from $13.50 to $750. That’s about 5,000 percent. Now, he says he will lower the price, but there’s no indication of how much or, as of this writing, when (According to Web MD Daraprim is used with other medication (such as a sulfonamide) to treat a serious parasite infection (toxoplasmosis) of the body, brain, or eye or to prevent toxoplasmosis infection in people with HIV infection).

As it turns out, though, the “World’s Biggest A–Hole case is not in the least bit unusual, it happens with pharmaceutical companies with great regularity as a tactic to increase profits on older drugs, drugs that have long since paid for themselves.

The global market for pharmaceuticals topped $1 trillion in sales in 2014. The world’s 10 largest drug companies generated $429.4 billion of that revenue. Five of these companies are headquartered in the U.S. They are: Johnson & Johnson, Pfizer, Abbot Laboratories, Merck and Eli Lilly.

Johnson and Johnson, America’s biggest pharmaceutical manufacturer raised prices on over 130 brand name products this year alone. Merck & Co. raised the price of 38 drugs. The increases in the U.S. have added over a billion dollars of revenue in the last three years. So, while Mr. Shkreli may get the award for being the biggest you know what, he is in good company — only the others were smart enough not to brag about it.

Before I go on it is important to point out that my interest in the topic is both personal and professional. I am a senior citizen, who has had a heart transplant and who also has Chronic Obstructive Pulmonary Disease (COPD). I take a good number of prescription drugs and despite having Medicare Part D insurance I still pay thousands of dollars a year for my prescriptions. Most of the drugs I take have been around for quite a while, but not long enough to allow the sale of generics and because there are few if any pricing restrictions, most of my meds are outrageously high priced.

One of the drugs I take is called Foradil. It was approved by the FDA in February 2001 for the maintenance treatment of asthma and the prevention of bronchospasm in reversible obstructive airways disease. Despite being on the market that long, it still retails for about $250.00 for a 30 day supply. Spiriva is another COPD drug and is often taken with Foradil. It retails for about $350.00. I take about a dozen drugs and these two alone total over $600.00 a month. Insurance cuts that cost in half, but they are still expensive. Because of these prices I know of many seniors and others who have to choose between eating and paying for their prescription meds.

In Europe, Asia, Australia and anywhere else with some form of socialized medicine strict government regulation helps prevent those kinds of actions and subsequently keeps prices down. Things are a whole lot looser in the U.S.

In 2013 each of us spent over $1,000 on prescription drugs. That works out to $429 billion. In case that figure boggles your mind, let me boggle it more by showing you what it looks like in black and white — $429,000,000,000. By anyone’s measure that’s a lot of money. To put it all in perspective Prescription medications make up close to 10 percent of the $2.9 trillion annual total spent on healthcare in the U.S.

Americans spend more on drugs than any other country in the world and – we also pay more for them than any other country.

big pharmaBefore we go into detail on why prescription drugs cost more here than anywhere else, let’s look at the biggest drug and biotech companies in the world. They account for more than a third of the industry’s total market share according to the World Health Organization. We won’t go into detail but here’s the top ten and their 2014 revenue.

  • Gilead Sciences $24.474 billion.
  • Bayer $25.47 billion.
  • AstraZeneca $26.095 billion.
  • GlaxoSmithKline $37.96 billion.
  • Merck’$42.237 billion.
  • Sanofi $43.07 billion.
  • Pfizer 49.605 billion.
  • Roche $49.86 billion.
  • Johnson & Johnson $74.331 billion.

If you were to ask any of those companies why prescription drugs cost so much they would likely tell you that the price reflects the immense costs of research and development. They would explain that it costs millions andcosts millions of dollars to develop a new drug and then millions more to get through animal and human studies and FDA approval, and that’s partially true. Partially. Those costs are very high, but what big pharma won’t tell you is that you are also paying for the costs of marketing the drug to physicians and patients and those costs dwarf the research and development expense. http://tinyurl.com/pr23j3q

The world’s largest pharma company, Johnson & Johnson, spent $17.5 billion on sales and marketing in 2013, compared with $8.2 billion for R&D. Most of that marketing effort is aimed directly at physicians, the people who write the prescriptions, rather than customers like you and me. It should be noted that the U.S. and New Zealand are the only two countries that allow any form of advertising for prescription drugs.

No sane person can object to a company making a profit, it’s part of the American way, but the drug industry’s profits are excessive. At the risk of being accused of repetitiveness I must say again. We pay significantly more than any other country for the exact same drugs. United States spends more than $1,000 per person per year on pharmaceuticals. Per capita drug spending in the U.S. is about 40 percent higher than Canada, 75 percent greater than in Japan and nearly triple the amount spent in Denmark. So why is that?

Well, first the U.S. is a very rich and therefore lucrative market because we use more medicine than any other developed country. We account for 35 percent of the world market for pharmaceuticals. Americans have become quite accustomed to leaving their doctor’s office with a handful of prescriptions.

Due to our ill health and our wealth, companies often choose the U.S. in which to launch new products. And, because the US market is so big and profitable, investments in research and development have long been steered towards meeting clinical needs.

But if we Americans take more prescription drugs, we also pay an arm and a leg more for them. Why? Because other countries have tough regulations about pharmaceutical prices and they set reimbursement limits. MedicareAnother smart thing they do is to agree to pay for a drug only if the price is justified by the medical benefits. In the U.S., Medicare which is the world’s largest buyer of prescription drugs is prohibited from negotiating prices with drug companies. If the company says that a pill is $100, Medicare has no choice, but to pay it if the patient needs it. They have no wiggle room and that costs taxpayers billions of dollars a year in a direct giveaway to the pharmaceutical behemoths and speaks to the power of their lobbyists.

Speaking of lobbyists, here’s the real rub. The pharmacy industry views congress as a place to invest against future price controls and this is what really adds to the price of your prescriptions.

Big Pharma Spends More on Lobbying Than Anyone
lobbyistsSince 1998, the industry spent more than $5 billion on lobbying in Washington, according to the Center for Responsive Politics. To put that in context, that’s more than the $1.53 billion spent by the defense industry and more than the $1.3 billion forked out by Big Oil.

From 1998 to 2013, Big Pharma spent nearly $2.7 billion on lobbying expenses — more than any other industry and 42 percent more than the second highest paying industry: insurance. And since 1990, individuals, lobbyists and political action committees affiliated with the industry have doled out $150 million in campaign contributions.

Now here’s how it works for you and me. In the U.S. insurers only accept the price set by the drug makers. If the drug is exclusive, meaning there is no competing medication from other companies. Insurers then cover the total cost by forcing a higher co-pay on patients. Unlike Medicare, insurers have bargaining power when there are competing drugs and therefore can reduce the co-pays.

generic drugs1Then, there is the Generic drug market, those are drugs in which the patent has run out and other manufacturers are allowed to produce the product. As an example the antidepressant Remeron is also known by its generic name Mirtazapine. Remeron is the brand name given it by the original manufacturer, but Mirtazapine can be made and distributed by any pharma company and sold for a much lower price.

Competition in that area is fierce and generic drug prices are usually low. Today generics account for about 85 percent of drugs dispensed in the U.S.

Despite generics and their low prices, there are still many Americans who daily make the choice between food or drugs, between paying the rent and drugs or giving up some other type of health care in order to afford the drugs that keep them going. Many Americans don’t take their recommended prescriptions because they can’t afford them. One recent survey showed that about one in five U.S. adults did not fill their prescription or skipped doses due to cost as opposed to Australia and some other countries where the ratio is one in ten. http://tinyurl.com/pejvoyn

Some people have turned to foreign sources for their prescriptions and advairthere are many with some of the more popular ones thriving in Canada. Here’s an example of the savings that can be had. If you want a three month supply of the popular asthma inhaler Advair it will likely cost you somewhere in the neighborhood of $600 to purchase it from one of your local pharmacies. If you select one of the Canadian pharmacies you can import the same three month supply of the same medication, Advair, for about $150, with shipping included. That amount may not mean much to the Donald Trump tax bracket, but to average Americans it’s a whole lot of money. Advair is just the tip of the iceberg. ABC news reports the following price comparisons:

  • Mirapex, for Parkinson’s disease: $157 in Canada vs. $263 in the United States.
  • Celexa, for depression: $149 in Canada vs. $253 in the United States.
  • Diovan, for high blood pressure: $149 in Canada vs. $253 in the United States.
  • Oxazepam, for insomnia: $13 in Canada vs. $70 in the United States.
  • Seroquel, for insomnia: $33 in Canada vs. $124 in the United States.

Tufts University in Boston released a study in the year 2000 that placed the cost of approval for a single drug at $802 million, and that was fifteen years ago. To be fair it must be revealed that the dollar amount adds in each successful drug’s prorated share of failures (only one out of fifty drugs eventually reaches the market), but that still does not explain why the retail price is higher here than anywhere else.

The only logical explanation I can come up after some a fair amount of research is that pharmaceutical companies can get away with much higher prices in the U.S. and they can’t elsewhere. Period!

So what are your options, what can average patients who have difficulty Optionaffording some drugs do to stay healthy and be able to eat and pay their rent and other bills at the same time?

Well, there are several steps you can take. Among them are:

  • Contact state and federal legislators and ask them to allow Medicare to negotiate the price of prescription drugs
  • Also ask them to allow importing of essential drugs from foreign companies through approved pharmacies.
  • Ask big pharma companies to see if you qualify for their reduced prices for people who have trouble affording them.
  • Read the Consumers Report story on the issue. It will give you the information you need to identify trustworthy pharmacies. http://tinyurl.com/qbflucm

But, if you are like me you want even more detail. Ok. Here’s the best I can do.

You can shop for the best price and because of the internet that’s become a whole lot easier. You can look up a specific drug and find the best price at a pharmacy near you. Here are two resources. I’m sure you can find a lot more https://www.lowestmed.com/Search#/  orhttp://www.goodrx.com/ All you have to do is type in the drug you need and your zip code and it will find the price of that drug in pharmacies near you.

Transplant recipients might be interested in the cost of anti-rejection drugs. The price is hard to stomach but easy to find. In my zip code 32244 100 Mg Cyclosporine capsules range in price from $526.00 at Wall Mart to $584 at Target. If you are a heart patient and take Carvedilol in my neighborhood it ranges from $4.00 at Wal Mart to $9.54 at Kmart. Lisinopril also has a wide range. At the Publix Supermarket pharmacy near me it is FREE…that’s right FREE.  But at CVS it is $12.00.  Those price variations might make it worth a little longer drive to get a better bargain.

You can also get help with coupons which are an obvious choice to savecouponmoney when grocery or clothes shopping, but they’re often overlooked as a way to cut costs of over-the-counter and prescription drugs. Manufactures frequently offer one time and repeat coupons that can save consumers hundreds of dollars on their medicines. “For our family it has been incredibly effective [in saving money] for a number of regular prescriptions,” says Stephanie Nelson, founder of the coupon website CouponMom.com.

The costs of prescription drugs and over-the-counter medications have been steadily rising and patients facing tight budgets are often forced to make hard decisions when it comes to what they can afford.

The savings vary by manufacturer, but many companies offer discounts at each prescription refill while others offer discount cards that take $20 off co-pays. Others offer one-time coupons to cover the first use of a drug.

  • Consumer Reports Magazine says that there are other ways to save money, too. Whichever drugstore or pharmacy you use, choosing generics over brand-name drugs will save you money. Talk to your doctor, who may be able to prescribe lower-cost alternatives in the same class of drug. In addition, follow these CR tips.
  • Request the lowest price. Our analysis showed that shoppers didn’t always receive the lowest
    available price when they called the pharmacy. Sometimes they were given a discounted price, and other times they were quoted the list price. Be sure to explain—whether you have insurance or not—that you want the lowest possible price. Our shoppers found that student and senior discounts may also apply, but again, you have to ask.
  • Leave the city. Grocery-store pharmacies and independent drugstores sometimes charge higher prices in urban areas than in rural areas. For example, our shoppers found that for a 30-day supply of generic Actos, an independent pharmacy in the city of Raleigh, N.C., charged $203. A store in a rural area of the state sold it for $37.
  • Get a refill for 90 days, not 30 days. Most pharmacies offer discounts on a three-month supply.
  • Consider paying retail. At Costco, the drugstore websites, and a few independents, the retail prices were lower for certain drugs than many insurance copays.
  • Look for additional discounts. All chain and big-box drugstores offer discount generic-drug programs, with some selling hundreds of generic drugs for $4 a month or $10 for a three-month supply. Other programs require you to join to get the discount. (Restrictions apply and certain programs charge annual fees.)
  • Experts say that although the low costs could entice you to get your prescriptions filled at multiple pharmacies, research indicates that it’s best to use a single pharmacy. That keeps all of the drugs you take in one system, which can help you avoid dangerous drug interactions.”

Finally, what do you do if you’ve done the shopping, used coupons, followed all of the Consumer Report Tips and are still unable to pay for your prescriptions? Well, there is some limited assistance. Here are some resources.

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bob half of bob and jay photoBob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s over 4,200 member Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love. You can register to be a donor at http://www.donatelife.net.  It only takes a few minutes. Then, when registered, tell your family about your decision so there is no confusion when the time comes.

 

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How to Get the Most Bang for Your Prescription Medicine Buck


By Bob Aronson

cartoonI am a senior citizen, who has had a heart transplant and who also has Chronic Obstructive Pulmonary Disease (COPD).  I take a good number of prescription drugs and despite having Medicare Part D insurance I still pay thousands of dollars a year for my prescriptions.  Most of the drugs I take have been around for quite a while, but not long enough to allow the sale of generics and because there are few if any pricing restrictions, most of my meds are outrageously high priced.

One of the drugs I take is called Foradil.  It was approved by the FDA in February 2001 for the maintenance treatment of asthma and the prevention of bronchospasm in reversible obstructive airways disease..  Despite being on the market that long, it still retails for about $250.00 for a 30 day supply.  Spiriva is another COPD drug and is often taken with Foradil.  It retails for about $350.00.  I take about a dozen drugs and these two alone total over $600.00 a month. Insurance cuts that cost in half, but they are still expensive.  Because of these prices I know of many seniors and others who have to choose between eating and paying for their prescription meds.

It is an unfortunate fact of life that prescription drugs are more expensive in America than any other place in the world and as a result if you contract a serious illness like cancer you may not be able to afford the treatment that can save your life, even if you are insured.

It costs a whole lot of money to be sick in this country and a whole lot of people die — not because there iscartoon two no medicine or treatment but because they can’t afford to get well.  That strikes me as being just plain wrong.

Healthcare costs are skyrocketing, but prescription drugs lead the parade. Americans now spend a staggering $200 billion a year on them and the end is nowhere in sight.  The cost of staying alive is growing at the rate of about 12 percent a year.  It appears as though people are taking a lot more drugs than they used to and they are taking the really expensive new ones instead of older, cheaper drugs.  The reason?   Either physicians are pushing new medications too hard or, more likely, people are seeing the ads for new drugs in the media and are demanding them.  Strangely, unlike most other businesses where prices come down with time, that’s not true with drugs.  Price increases are commonplace even with the older ones and the increases aren’t one time adjustments. Often the price tag increases several times a year.

Earlier I pointed out that Americans pay more for their drugs than any other country in the world — but it isn’t just a little more…it’s a whole lot.  On average, the cost of prescription drugs in the U.S. is at least double what people in other countries pay for the same exact prescription and it some cases it is 10 times more.

A 2013 report from the International Federation of Health Plans, says Nexium, the pill commonly prescribed for acid reflux, costs U.S. patients more than $200, while Swiss citizens only pay $60 and people who live in the Netherlands pay $23. But Nexium is a drop in the bucket compared to cancer drugs. http://www.drugwatch.com/2014/10/15/americans-pay-higher-prces-prescription-drugs/

Not long ago CBS’ 60 Minutes devoted a segment to the absurdly high cost of cancer drugs. Correspondent Lesley Stahl reported that many cancer drugs cost well over $100,000 for a year’s worth of medicine. She said that in the fight against cancer, most people can expect to be on more than one drug. The bill for medications can escalate to nearly $300,000, a price tag that doesn’t include fees charged by a doctor or a   hospital. Health insurance companies – including government polices like Medicare – don’t cover the full cost of these drugs. Some policies don’t cover some of these drugs at all. cancerrBut cancer is not alone in the extreme price arena. Drugs for chronic diseases like multiple sclerosis also carry inflated prices. Prescriptions of Copaxone and Gilenya cost about $4,000 and $5,500, respectively and that amount is almost three times more than the most-expensive price in other countries.

In the case of almost every other product sold on the free market, the older a product gets the less it costs. In the case of cancer drugs in America, the inverse is actually true. Novartis developed Gleevec, one of the most popular cancer drugs, in 2001 and sold it for $28,000 a year. By 2012, its cost rose to $92,000. Despite not being a novel treatment, Novartis is allowed to hike up the price every year in the United States.

So If you are a reasonably intelligent person you will ask three questions.  1) Why do these drugs cost so much? 2) What is being done to bring the prices down? And 3) Is there help available to people who can’t afford the drugs that can keep them alive.

Let’s answer the questions one at a time.  First.  Why are drugs so expensive?  Well, if you listen to the bigbig pharma pharma companies they will tell you that the cost reflects their investment in research and development of the drugs.  They will tell you they spend millions on drugs that don’t pan out and that expense is passed on to the patient.  But are they telling the truth?  No they aren’t! Pharmaceutical companies are fond of saying Americans take the lion’s share of the R&D costs for the rest of the world – calling other countries “foreign free riders.” So, drug companies are forced to charge Americans more to recover what they don’t get from other countries.

In fact, the more disturbing truth is that companies charge what they want in the U.S., and it’s a profiteering paradise for them.  U.S. law protects these companies from free-market competition.  For example, Medicare is not allowed to negotiate prices. By law, it has to pay exactly what the drug companies charge for any drug.  In effect our lawmakers told the pharmaceutical companies that they can charge whatever they want and we (the taxpayers) will pay it. Even may insurance companies don’t negotiate or do it half-heartedly.  Companies make billions on most of these drugs, and they receive massive tax breaks for R&D, leading to inflated figures. Another huge portion of the costs are subsidized by taxpayers.

Here’s the sad part of all this R and D and the introduction of new drugs.  Only 1 in 10 of them actually provides substantial benefit over old drugs.  To add insult to injury the side effects of the new entries create the need for more drugs. And — some of these drugs have horrible complications that result in lawsuits to recover damages.

University of Medicine and Dentistry of New Jersey Health professor and policy expert Donald W. Light says, “We can find no evidence to support the widely believed claims from industry that lower prices in other industrialized countries do not allow companies to recover their R&D costs so they have to charge Americans more to make up the difference and pay for these ‘foreign free riders,’”

In contrast, governments in other countries put caps on the price of drugs and negotiate prices based on what the actual therapeutic benefit is. And Big Pharma still turns a healthy profit in other countries, despite costs being 40 percent lower than they are in the United States.

Big Pharma would have many Americans believe that it is disadvantaged by the costs of developing a new drug. The truth is, drug companies are far from impoverished. EvaluatePharma’s most recent report shows that 2013 was the biggest year since 2009 for drug approvals. These new drugs will add nearly $25 billion to Big Pharma’s coffers by 2018, and prescription drug sales will exceed one trillion dollars by 2020.

The health care industry as a whole has more than enough money, with billions left to continue pursuing its interests in Washington.

Big Pharma Spends More on Lobbying Than Anyone

campaign contributionsSince 1998, the industry spent more than $5 billion on lobbying in Washington, according to the Center for Responsive Politics. To put that in context, that’s more than the $1.53 billion spent by the defense industry and more than the $1.3 billion forked out by Big Oil.

From 1998 to 2013, Big Pharma spent nearly $2.7 billion on lobbying expenses — more than any other industry and 42 percent more than the second highest paying industry: insurance. And since 1990, individuals, lobbyists and political action committees affiliated with the industry have doled out $150 million in campaign contributions.

The world’s 11 largest drug companies made a net profit of $711.4 billion from 2003 to 2012. Six of these companies are headquartered in the United Sates: Johnson & Johnson, Pfizer, Abbot Laboratories, Merck, Bristol-Myers Squibb and Eli Lilly. In 2012 alone, the top 11 companies earned nearly $85 billion in net profits. According to IMS Health, a worldwide leader in health care research, the global market for pharmaceuticals is expected to top $1 trillion in sales by 2014.http://www.drugwatch.com/manufacturer/

But the large amount of cash Big Pharma bestows on government representatives and regulatory bodies is small when compared with the billions it spends each year on direct-to-consumer advertising. In 2012, theadvertising industry invested nearly $3.5 billion into marketing drugs on the Internet, TV, radio and other outlets. The United States is one of only two countries in the world whose governments allow prescription drugs to be advertised on TV (the other is New Zealand).

A single manufacturer, Boehringer Ingelheim, spent $464 million advertising its blood thinner Pradaxa in 2011. The following year, the drug passed the $1 billion sales mark. The money in this business appears to be well-spent.

No sane person can object to a company making a profit, it’s part of the American way, but the drug industry’s profits are excessive.  We paysignificantly more than any other country for the exact same drugs. Per capita drug spending in the U.S. is about 40 percent higher than Canada, 75 percent greater than in Japan and nearly triple the amount spent in Denmark.

So you might ask, “What can I do to get the lowest possible price for my  prescriptions?”  Well, there are a few things.  You can shop for the best price and because of the internet that’s become a whole lot easier.  You can look up a specific drug and find the best price at a pharmacy near you.  Here are two resources, I’m sure you can find a lot more https://www.lowestmed.com/Search#/  or http://www.goodrx.com/ All; you pharmacieshave to do is type in the drug you need and your zip code and it will find the price of that drug in pharmacies near you.

Transplant recipients might be interested in the cost of anti-rejection drugs.  The price is hard to stomach but easy to find.  In my zip code 32244 100 Mg Cyclosporine capsules range jn price from $526.00 at Wal Mart to $584 at Target.  If you are a heart pateint and take Carvedilol in my neighborhood it ranges from $4.00 at WalMart to $9.54 at Kmart . Lisinopril also has a wide range.  At the Publix Supermarket pharmacy near me it is FREE…that’s right FREE.  But at CVS it is $12.00.  Those price variations might make it worth a little longer drive to get a better bargain.

You can also get help with coupons which are an obvious choice to save money when grocery or clothes shopping, but they’re often overlooked as a way to cut costs of over-the-counter and prescription drugs.  Manufactures frequently offer one time and repeat coupons that can save consumers hundreds of dollars on their medicines.  “For our family it has been incredibly effective [in saving money] for a number of regular prescriptions,” says Stephanie Nelson, founder of the coupon website CouponMom.com.

The costs of prescription drugs and over-the-counter medications have been steadily rising and patients facing tight budgets are often forced to make hard decisions when it comes to what they can afford.

The savings vary by manufacturer, but according to Nelson, many companies offer discounts at each prescription refill while others offer discount cards that take $20 off co-pays. Others offer one-time coupons to cover the first use of a drug.

Consumer Reports Magazine says that there are other ways to save money, too.  Whichever drugstore or pharmacy you use, choosing generics over brand-name drugs will save you money. Talk to your doctor, who may be able to prescribe lower-cost alternatives in the same class of drug. In addition, follow these tips.

  1. Request the lowest price.Our analysis showed that shoppers didn’t always receive the lowest couponavailable price when they called the pharmacy. Sometimes they were given a discounted price, and other times they were quoted the list price. Be sure to explain—whether you have insurance or not—that you want the lowest possible price. Our shoppers found that student and senior discounts may also apply, but again, you have to ask.
  2. Leave the city.Grocery-store pharmacies and independent drugstores sometimes charge higher prices in urban areas than in rural areas. For example, our shoppers found that for a 30-day supply of generic Actos, an independent pharmacy in the city of Raleigh, N.C., charged $203. A store in a rural area of the state sold it for $37.
  3. Get a refill for 90 days, not 30 days.Most pharmacies offer discounts on a three-month supply.
  4. Consider paying retail.At Costco, the drugstore websites, and a few independents, the retail prices were lower for certain drugs than many insurance copays.
  5. Look for additional discounts.All chain and big-box drugstores offer discount generic-drug programs, with some selling hundreds of generic drugs for $4 a month or $10 for a three-month supply. Other programs require you to join to get the discount. (Restrictions apply and certain programs charge annual fees.)
  6. Consumer Reports goes on to say that “although the low costs we found at a few stores could entice you to get your prescriptions filled at multiple pharmacies based only on price, our medical consultants say it’s best to use a single pharmacy. That keeps all of the drugs you take in one system, which can help you avoid dangerous drug interactions.”

Finally, what do you do if you’ve done the shopping, used coupons, followed all of the Consumer Report Tips and are still unable to pay for your prescriptions.  Well, there is some limited assistance. Here are some resources.

  1. http://www.medicare.gov/pharmaceutical-assistance-program/

2.http://www2.nami.org/Content/ContentGroups/Helpline1/Prescription_Drug_Patient_Assistance_Programs.htm

  1. http://healthfinder.gov/rxdrug

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bob 2Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s over 4,200 member Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at bob@baronson.org.  And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.  You can register to be a donor at http://www.donatelife.net.  It only takes a few minutes.

Commonly Used Medical Terms Made Clear


By Bob Aronson

cartoonTo most of us the abbreviations and phrases used in the medical world are another language from another planet.   Few understand what is written on the prescription they take to the pharmacy just as they don’t always understand the discharge instructions they get from a hospital or an emergency room.

To save time and clarify communication internally medical professionals have developed a very special system of codes, abbreviations and phrases that are quite exact in their meaning.  Unfortunately these same professionals often forget that the rest of us don’t have their training, education and expertise and use this “internal” language on patients who are often left dumbfounded because of a reluctance to ask for clarification.

The picture to the right is a real prescription and when you see it for the first time you probably are struck by the sameillegible prescription question most of us have, “How on earth does the pharmacist read that mess?”  Well,  the answer is that pharmacists understand the code words, phrases and abbreviations used by physicians but, they get stumped just like you do so they call and ask for clarification.   You should do that, too.   If you aren’t perfectly clear about what your medicine is and what it does you should seek clarification  first from your doctor and then from the pharmacist.

The list of common medical terms below was taken from several sources and I have tried to simplify it as best I could but should you be confronted with these terms or others not listed here that you still don’t understand don’t be afraid to ask and ask again until you have a perfectly clear explanation.  After all, it is your health, your body and your life and the medical people owe you a clear explanation of your condition, your diagnosis, prognosis and treatment plan including the medicine they have prescribed and what it does.

Miscommunication can be deadly.  You owe it to yourself to ask a lot of questions.  If you have done that and find that after processing what you heard you have more questions you should call your physician’s office for clarification. Do the same with your pharmacist or any other medical professional with whom you have contact.

Below is a list of the most common medical terms and abbreviations.  Note…you will see a mixture of upper and lower case entries.  These are not typos.   It is the way they are actually written.

Common prescription terms and abbreviations

AD: up to (defining a limit.)

BUSS: Inside the cheek

C: (With a straight line over the top ): With

cf: With food

h.s.: at bedtime

bid: twice a day

tid: three times a day

qd: daily

o.p.d.: once per day

q.a.d.: every other day

q.i.d: four times a day

sig: write on label

SL: sublingually, under the tongue

WF : with food

Terms and abbreviations used in prescriptions and elsewhere

a.c.: Before meals. As in taking a medicine before meals.

Ad lib At liberty. For example, a patient may be permitted to move out of bed freely and orders would, therefore, be for activities to be ad lib.

AKA: Above the knee amputation.

Anuric: Not producing urine.  That means the patient may need dialysis.

Bibasilar: At the bases of both lungs. For example, someone with pneumonia in both lungs might have abnormal  breath sounds.

BKA: Below the knee amputation.

BMP: Basic metabolic panel blood test.

BP: Blood pressure.. Blood pressure is one of several vital signs.

BSO: Bilateral salpingo-oophorectomy.  The removal of both of the ovaries and adjacent Fallopian tubes often part of a total abdominal hysterectomy.

C/O: Complaint of. The patient’s expressed concern.

cap: Capsule.

CBC: Complete blood count

CC: Chief complaint. The patient’s main concern.

cc: Cubic centimeters.

Chem panel: Chemistry panel. A comprehensive screening blood test to determine the status of the liver, kidneys and electrolytes.

COPD: Chronic obstructive pulmonary disease.

CVA: Cerebrovascular Accident (stroke)

D/C or DC: Discontinue or discharge. Adoctor will D/C a drug or DC a patient from the hospital.

DM: Diabetes Mellitus.

DNC, D&C, or D and C: Dilation and curettage.  Widening the cervix and scrapping with a curette for the purpose of removing tissue lining the inner surface of the uterus.

DNR: Do not resuscitate. This is a specific order not to revive a patient artificially if they succumb to illness. If a patient is given a DNR order, they are not resuscitated if they are near death and no code blue is called.  Usually requested by the patient or family.

DOE: Dyspnea on exertion. Shortness of breath with activity.

DTR: Deep tendon reflexes. These are reflexes that the doctor tests by banging on the tendons with a rubber hammer.

DVT: Deep venous thrombosis (blood clot I large vein).

FX: Fracture.

H&H: hemoglobin and hematocrit.  When the H & H is low, anemia is present.

H&P: History and physical examination.

h.s.: At bedtime. As in taking a medicine at bedtime.

H/O or h/o: History of. A past event that occurred.

HA: Headache.

HTN: Hypertension (high blood pressure)


I&D: incision and drainage.

IM: Intramuscular.. This is a typical notation when noting or ordering an injection (shot) given into muscle..

IMP: Impression. This is the summary conclusion of the patient’s condition by the healthcare practitioner at that particular date and time.

In vitro: In the laboratory.

In vivo: In the body.

IU: International unit

JT: Joint

K: Potassium. An essential electrolyte frequently monitored regularly in intensive care.

KCL: Potassium chloride.

LBP: Low back pain. LBP is one of most common medical complaints.

LLQ:: Left lower quadrant.

LUQ:: Left upper quadrant..

Lytes: Electrolytes (potassium, sodium, carbon dioxide, and chloride).

MCL: Medial collateral ligament.

mg: Milligrams.

ml: Milliliters.

MVP: Mitral valve prolapse.

N/V: Nausea or vomiting

Na: Sodium. An essential electrolyte frequently monitored regularly in intensive care.

npo: Nothing by mouth. Often ordered when a patient is about to undergo surgery requiring general anesthesia.  It means no food or drink.

O&P: Ova and parasites.  Stool O & P is tested in the laboratory to detect parasitic infection in persons with chronic diarrhea..

O.D.: Right eye.

O.S.: Left eye.

O.U.: Both eyes.

ORIF: Open reduction and internal fixation such as with the orthopedic repair of a hip.

P: Pulse. Pulse is recorded as part of the physical examination. It is one of the “vital signs.”

p.o.: By mouth. From the Latin terminology per os.

p.r.n.: As needed. Example a pain killer may be taken only when the patient has pain or “as needed.

PCL: Posterior cruciate ligament..

PERRLA: Pupils equal, round, and reactive to light and accommodation.

Plt: Platelets, one of the blood forming elements along with the white and red blood cells.

PMI: Point of maximum impulse of the heart when felt during examination, as in beats against the chest.

q2h: Every 2 hours. As in taking a medicine every 2 hours.

q3h: Every 3 hours. As in taking a medicine every 3 hours.

qAM: Each morning. As in taking a medicine each morning.

qhs: At each bedtime. As in taking a medicine each bedtime.

qod: Every other day. As in taking a medicine every other day.

qPM: Each evening. As in taking a medicine each evening.

R/O: Rule out. Doctors frequently will rule out various possible diagnoses when figuring out the correct diagnosis..

REB: Rebound, as in rebound tenderness of the abdomen when pushed in and then released.

RLQ: Right lower quadrant. The appendix is located in the RLQ of the abdomen.

ROS: Review of systems. An overall review concerns relating to the organ systems, such as the respiratory, cardiovascular, and neurologic systems.

RUQ: Right upper quadrant. The liver is located in the RUQ of the abdomen.

s/p: Status post. For example, a person who had a knee operation would be s/p a knee operation.

SOB: Shortness of breath.

SQ: Subcutaneous.. This is a typical notation when noting or ordering an injection (shot) given into the fatty tissue under the skin, such as with insulin for diabetes.

T: Temperature. Temperature is recorded as part of the physical examination. It is one of the “vital signs.”

T&A: Tonsillectomy and adenoidectomy.

tab: Tablet

TAH: Total abdominal hysterectomy..

THR: Total hip replacement.

TKR: Total knee replacement.

UA or u/a: Urinalysis.. A UA is a typical part of a comprehensive physical examination.

URI: Upper respiratory infection like sinusitis or the common cold

ut dict: As directed. As in taking a medicine according to the instructions that the healthcare practitioner gave in the office or in the past.

UTI: Urinary tract infection.

VSS: Vital signs are stable. This notation means that from the standpoint of the temperature, blood pressure, and pulse, the patient is doing well.

Wt: Weight. Body weight is often recorded as part of the physical examination.

Commonly used prefixes and suffixes

http://www.bubblews.com/news/2020191-what-did-the-doctor-just-say-some-common-medical-terms-prefixes-and-suffixes

Prefixes

1. “Angio…”
Related to the blood vessels
(Angioplasty, etc.)

2. “Lobo…”
Relating to either the brain or lungs.
(Lobotomy, etc.)

3. “Nephro…”
Relating to the kidneys.
(A Nephrologist is a doctor who specializes in medical conditions impacting the kidneys.)

4. “Hyster …”
Relating to the uterous.
(Hysterectomy, etc.)

5. “Gastro …”
Relating to the atomach
(Gastroenteritis, etc.)

6. “Myo…”
Related to muscle tissue.

6. “Arthr…”
Related to the joints.
(Arthritis, arthoscopic surgery, etc.)

7. “Encephal…”
Related to the brain
(Encephalitis, encephlitiform activity, i.e. seizures.)

Suffixes

1. Something or other… “itis”
Whatever the ‘something’ is is inflamed and possibly infected.
(Pancreatitis, appendicitis, tonsilitis, etc.)

2. “…ectomy”
The removal of whatever body part precedes it.
(Appendisectomy, tonsilectomy, hemorrhoidectomy, hysterectomyetc.)

3. “… otomy”
A surgical incision into whatever precedes it.

4. “… scentesis”
The surgical puncturing of something – deliberately
(Amnioscentesis to draw fluid from the uterine sac to check on the condition of a fetus.)

5. “…septic”
From a Greek word meaning putrefaction (rotting), as “spsis” it is used to refer to an infection of the entire system, particularly through the circulatory (blood) system and is considered quite seious.
The opposite, of course, is “Antiseptic”… the purification of something from germs and bacterial contamination.

6. “… ostomy”
The putting a hole in something in the hopes that it will help it function better.
(colonostomy)

7. “… plasty”
To modify or reshape.
(A “nose job” is a rhinoplasty, etc.)

-0-

Bob informal 3Bob Aronson is a 2007 heart transplant recipient, the founder and primary author of the blogs on this site and the founder of Facebook’s over 3,000 member Organ Transplant Initiative group.

Now retired and living in Jacksonville, Florida with his wife Robin he spends his time advocating for patients with end stage diseases and for organ recipients.  He is also active in helping his wife with her art business at art festivals and on her Rockin Robin Prints site on Etsy. 

Bob is a former journalist, Governor’s Communication Director and international communications consultant.

This List Could SaveYour Life


The 2012 Frankenstorm that started out as hurricane Sandy had a devastating effect on the eastern seaboard of the United States.   In situations like that it is critically important for the sick, elderly and those who are recovering from organ/tissue transplants and other procedures to be specially prepared to provide accurate medical information to emergency responders.

Being prepared for Frankenstorms is essential but mini storms pop up every day.  You never know when for no apparent reason your blood pressure increases dramatically,  you have difficulty breathing, you experience unexplainable weight gain or an angina attack sends you to the emergency room.  When that happens someone is going to ask what meds you are on, how often you take them, their dosage, contact information for your medical team and insurance info.  Under pressure and when sick it is not uncommon to forget important information.  That’s why I developed this list.   If you have already done what I recommend then review and update your effort.  If you haven’t, do it now while you have the time.

Developing the following information could save your life. There is nothing that can help emergency responders or medical professionals more than providing them with the information suggested below. It is critically important to your life that you take the time right now to do the following:

Information to include on an emergency medical information fact sheet: (sample at the end of this blog)

  • Your full name, address and phone number
  • Next of kin or person(s) who should be notified in case of your emergency including contact information (names, phone, address, email, cell phone)
  • Your Primary care physician name and phone number
  • Specialty care physicians names and numbers
  • The pharmacies you use (include phone numbers)
  • Health insurance company, agent and policy numbers (If on Medicare or Medicaid include that notation with account numbers).
  • Prescription insurance numbers
  • List all the medical conditions for which you are being treated
  • List all surgeries
  • Blood type
  • Write down every medication you take whether by prescription or over the counter.  Include milligrams for each, how often you take them and for which medical condition.

DO NOT GO ANYWHERE WITHOUT AT LEAST A WEEK’S SUPPLY OF YOUR MEDS!   This is especially important during a disaster situation in which transportation, emergency and other services are strained, temporarily unavailable or even suspended.

Some people, transplant patients and recipients in particular must take certain medications to stay alive.  In situations like storms or other natural or unnatural disasters and emergency situations you could be faced with a situation in which you are unable to go home to retrieve your medications and other important belongings.  I suggest you do what I do and that is to keep a shoulder bag packed with your meds and other medical equipment that is within your reach at a moment’s notice. If possible you should also try to stash some cash in your emergency bag.  You might find yourself in a situation where checks and credit cards are useless.

If you have a cell phone and an extra charger, put it in your meds bag.  If you don’t have an extra charger keep the one you have in your meds bag when you are not using it. There is nothing worse than being unable to get to your charger when your phone is going dead.  That phone could be your link to safety and treatment.

If you wear a medical necklace or bracelet, make sure it is up to date and accurate.  If you don’t wear one and have time, get one.

When you have completed the medical emergency list (it should all fit on one sheet of copy paper) make two or three copies, fold them carefully and put them in your purse or wallet.  Emergency medical people can be of the most help if they are aware of your medical history, current medications and other treatments you may be getting.  Having that list in your possession and providing it to medical experts could save your life.  While you may know all of this information, do not depend on your memory.  One omission could prove to be catastrophic.  You must also remember to update the list every time you get a new medication, quit using one, or have any change in your medical condition.

A separate list should be developed for your personal use.  It should include phone numbers of emergency services you might need and iportant family and friend contacts you might need (include cell phone numbers and email addresses).

Sample Medical Info Sheet to Carry With You

HEART TRANSPLANT RECIPIENT

Best Hospital USA  August 21 2007  Immunosuppressed

John Doe

Birth date 2-17-1950

9180 orchard lane Anycity, USA

Home 555-555-5555  Cell phone 555-555-5555

SS # 555-55-5555

Spouse; Jane Doe; Cell phone 555-555-5555

Physicians:

Primary, Dr.Sawbones Anycity USA.  Address, phone numbers

Transplant Pulmonologist,  Dr. Breatheasy best clinic USA. 
Address, phone numbers

Transplant Cardiologists, Dr. Heartthump best clinic USA. 
Address, phone numbers

Transplant Coordinator:  Nurse Jane best clinic USA/
Address, phone numbers

 Pharmacy: 

Primary:  Best Pharmacy USS. 
Address, phone numbers

Secondary: Second best pharmacy USA. 
Address, phone numbers

 Health insurance:

Primary Medicare part A, Hospital, part B, Medical. Policy number other info

Secondary, AARP Medicare Supplement .   policy number other info

Medicare part D Prescriptions, AARP Medicare RxEnhanced policy number, other info

 

ALLERGIES:  Penicillin, cats, all seafood/fish, mold, dust.  

 BLOOD TYPE: B Positive

MEDICATIONS

 Heart related medications

  • Anti-rejection Cyclosporine 200 mg  twice a day
  • Anti-rejection — Cellcept  1000 mg twice a day
  • Anti-cholesterol — Prevastatin 20 mg once a day
  • Blood Thinner – Aspirin 81 mg once a day
  • Blood Pressure – Amlodipine Besylate 5 mg twice a day

Other medications

  • Reflux – Omeprozole  (Prilosec) two 40 mg twice a day
  • Thyroid — Levothyroxine .088 MG once a day  (upon arising)
  • Asthma – ProAir albuterol  rescue inhaler as needed
  • COPD – Foradilinhale one capsule twice a day
  • COPD – Spiriva inhale one capsule once a day (upon arising)
  • Depression-Remeron  7.5 –mg once a day-

 Supplements

—  Calcium – 600 mg tablet with Vitamin D twice a day

—  Multi-vitamin– one tablet once a day

Medical Conditions

  • Asthma, hay fever, allergies diagnosed 1951
  • Non-smoker
  • COPD diagnosed October 2000
  • Restless leg syndrome diagnosed 1996
  • Chronic lower back pain

Surgeries

  • Heart transplantBest Hospital 
  • Anywhere USA August 2007
  • Cholecystectomy 1994
  • Total left knee replacement 1998

This list is on my computer and on my cell phone.  Also, I carry two paper copies in my wallet at all times and update it whenever there is a condition, prescription, insurance or medical team change.  Every time I hand this list to ER personnel, or anyone else who asks for it they all say the same thing, “Everyone should carry a list like this it is of invaluable help to us and could save your life.”

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s over 3,000 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.

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