Monday, July 06, 2009

A Tiny Dose of Poison! Part 3 My Inadequacies

She timidly walked in the pharmacy; in a quiet voice, she politely asked the clerk to speak with me when I had a minute..'no hurry.' She patiently waited in a quiet aisle, as I finished the prescription order.

A neatly dressed female senior citizen, a member of the anonymous, disappearing middle class, her countenance was sad, worried, resigned to some unknown, hopeless fate. We moved to a private counseling area.

'It's my husband," she said, as she emptied a brown bag of her husband's medications. From the many bottles I knew he had advanced heart disease.

"We can no longer afford these medications. We have no savings, no prescription coverage or other health insurance, only Social Security, Medicare and small pension checks,"she said.

The wife began a litany about substantial prescription costs they could not continue to pay. Their home and all possessions were paid, she said. They retired here to save on daily living expenses and taxes, secure their savings, stretch pensions and Social Security further, she continued, in a halting voice, trying to hold back tears.

They had had good jobs with a medium sized corporation and retired, thinking they were secure with adequate pensions, Social Security, Medicare, health and prescription insurance from their long employment with the same company. As foreign competition increased, the pressure on their company to cut costs began. As with other companies, retirement promises were broken, abruptly terminated, to present and future retirees.. Pension funds were bankrupt, sometimes due to mismanagement. Health benefits were curtailed or cut. It seemed all the dire consequences that began to occur in the 1990s steamrolled collectively into this couple's front door.

She began to cry. The physician would not change drugs, even when there were suitable, less expensive alternatives. She never complained about our prices like others. She mentioned how carefully they budgeted their household expenses and substituted store brand groceries for name brands.

She tearfully asked "What did you suggest?"

At that moment I never felt so inadequate. Every feeble suggestion I had, would be nixed by her husband's unyielding physician. One prescription was for a long-acting 'twice a day' blood pressure medication. It was available in a generic tablet to be taken four times a day, the primary disadvantage of which is patient non-compliance. [Convenience of twice-a-day medications is more costly, but patient compliance is better.]

Finally, I referred her to a service where manufacturers provide 90-day supplies to patients that meet their criteria. Every 90 days the application process has to be repeated. These services are designed for persons who 'fall through the cracks' of other services like Medicaid. She was willing to give this service a try.

She profusely thanked me for my time,; I felt I had abysmally failed.

It's been nearly 13 years and I have not forgotten this middle income, neatly attired elderly lady trying to take care of her husband. There, except for the grace of God, go I.

In the present circumstances of our health care system with current proposals I can foresee where I might be in her situation. It appears services will diminish for old people. The message, as dire as it may sound, we should get out of the way, just go ahead and die.

A pharmacist/patient relationship develops over time as the patient continues to interact with the pharmacist in the course of counseling about their prescriptions. Throughout my career the retail prescription pricing was a major topic of discussion between patient and pharmacist. An expensive prescription in 1960 was $10; today the sky seems the limit. I remember when a new antibiotic was $1 per tablet. My three COPD inhalers are over $100 ea./mo. but I have insurance.

In the early days of my career the company line was the manufacturer costs included the costs of research and development, which to me and patients some was a nebulous entity in outer space. "Research and development" became the "company line."As years fled by I no longer spouted the "company line." When percentage increases in wholesale prices regularly exceeded annual cost of living increases, I saw no justification for "research and development."

Near the end of my career the wailing over prescription costs grew exponentially with every price increase. It seemed 10% wholesale increases once or twice a year were common and even 15% increases occurred with regularity. These increases were generally passed on to the patient, as in every business that deals with a commodity.

I came to believe pharmaceutical manufacturers were disingenuous in their explanations, when they began media advertising, especially television ads which may run $100,000/per 30 sec. for small viewer audiences to $1.5 million/30 sec. for a Super Bowl ad, a national viewing audience. F
urther, these ads provoke patients to insist their physician give them the latest remedy, even when there is less expensive alternatives.

My employers were not rolling in excess profits. Most net profits were 3%. Their inventories, like automotive floor plans, were mortgaged at the bank. A small inventory could exceed $1 million.

A National Healthcare Plan which includes prescriptions must dissect the phases of research, developing and manufacturing medications. I do not envy those charged with this task.

I am very thankful I am retired.
-------------------------------------------------------------------------------------------------Some small suggestions for shopping:

Where super discount chains exist, their competitive pricing usually cannot be beat. Wal-Mart will tell every pharmacy in their market area, they will match or beat every price of every competitor.

Pharmacies cannot routinely meet Wal-Mart's prices or their bulk buying power, so they try to be as near the competition as possible, but above it.

At least this is my experience with them.

However, for a few cents more, other pharmacies may offer delivery, shorter wait times, friendlier service. You decide what you are willing to pay. If you have prescription insurance cards, your co-pay is the same wherever you shop.

Your pharmacist should be willing to answer questions in a reasonable period of time. PLEASE remember the pharmacist is an expert on medications, not the practice of medicine. Our degrees ae PharmD, not MD.

I love to play doctor with myself or my husband, but when people ask my opinion, I tell them I am speculating and repeat it.

[I will be in Springfield MO, M-Th for medical consults. My trusty laptop will be with me, but not sure how much time I will be spending with computer. The motel has free WI FI !!!] <:~D)

When I return, I hope to be able to review the book of poetry, Reflections of a Mississippi Magnolia.


Silver said...

m' dear, i have an award waiting for you at my blog.. come pick it up, sweet!

Arkansas Patti said...

Wonderful, well written piece on a sad state of affairs for the elderly.
When in banking, I had customers come in lamenting that they thought they had provided for their retirement but did not allow for illness. I saw nice bank accounts drop to zero as doctors and medicines drained them.
We do need reform.
Hope your trip is pleasant with good news. Keep us informed.

Sweetie Pie said...

What an excellent and thought provoking post.

I hope all goes well with the doctors visits!!

Betty said...

Very interesting and informative post. Thank you.

Renie Burghardt said...

Thank you for this great post, Carol Ann. I hope you come back with good news.


Pat - Arkansas said...

Well said, NitWit. I once had to tell my doctor that I could not afford to take any of three particular medications he prescribed for me. When I told him how much they cost, he was either truly shocked, or really fooled me. I truly believe that he had no idea of the retail cost of the medications. Just the three of them would have set me back more than 60% of my total monthly income. He got a little lecture from me about needing to be aware of the financial impact on his fixed income patients.

Anonymous said...

I hope and pray that Obama will be able to get medical coverage for everyone. But with the mighty insurance lobbies and also doctor and hospital lobbies, I doubt it is possible. Maybe it really does take socialized medicine. Or, the government takes over the whole thing and runs it -- call it whatever...

Here is my comment on your knees on my post.

You don't have to get down on your knees or even bend them. If you can imagine reaching over to touch your toes. Legs straight...that's what this position is like except instead of touching your toes you are holding a camera in both hands and pressing the shutter button.