Medications and Prescribing

Physicians writing on KevinMD about prescribing: the prior authorization that stands between a prescription and a pharmacy, opioids and the tapers that followed the CDC guideline, GLP-1 drugs and what happens when patients stop them, compounded and direct-to-consumer drugs, shortages, and what a prescription costs the patient. Three maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Opioids: what physicians and pain patients say, in their own words, and GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words.

The impact of hiding medication costs from patients

Anonymous

Medications

September 24, 2011

Always covered by an employer health plan, I had never given a thought to prescription costs – my medications had been covered by moderate copays. This changed when I retired and enrolled in Medicare (and a Medicare Part D plan).

Just prior to retirement, my eyes suddenly began tear and swell so much that it impacted my vision. The eye doctor diagnosed an allergic reaction and prescribed prednisone drops to …

Requiring a prescription for OTC products is a waste of physician time

Edward Pullen, MD

Physician

September 12, 2011

Most OTC products, excepting some medical equipment like crutches and diabetic supplies, now cannot be purchased with flexible spending account dollars without a physician prescription.

One of my partners asked last week how I am dealing with this issue. He has had several patients ask for a long list of prescriptions for OTC products so that they can use their FSP to pay for these things with pre-tax dollars. This puts …

The worst abuse of an embargo this medical journalist has ever seen

Larry Husten, PhD

Medications

September 12, 2011

In general I support embargoes in medical journalism. Although the current system is far from perfect and contains all sorts of wrinkles and unexpected consequences, I support the system because it allows journalists a bit more time to work on complicated stories and to try to get them right. Recently, though, I came across the single worst abuse of an embargo that I have encountered in the course of my …

Should the elderly with dementia be given anti-psychotic drugs?

Merrill Goozner

Medications

September 4, 2011

The inspector general of HHS recently reported that nearly half of the anti-psychotic drugs fed to the demented elderly in nursing homes are inappropriately prescribed. That’s about one in fourteen nursing home residents.

Forget about cost, which is over a quarter billion dollars a year. “Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” wrote Daniel R. Levinson, the HHS I.G. wrote …

How the price of preventing a preterm pregnancy went up

Allen Perkins, MD

Medications

September 4, 2011

One of the reasons cited for our expensive health care system is that drugs cost more in America (part of our capitalistic system). In June of 2003, a study was published in the New England Journal of Medicine about the use of a form of progesterone to delay the birth of certain preterm infants. This particular hormone is found in the human body, but the formulation …

Physicians need to understand subtle marketing manipulation

Toni Brayer, MD

Medications

August 31, 2011

There is do doubt that the way pharmaceutical companies market drugs to both doctors and consumers sways prescribing and drives up health costs. Prescription drug costs have outpaced other health care spending and are predicted to exceed the growth rates for hospital care and physician services going forward from 2010-2019.

Two researchers (Howard Brody, MD, PHD, University of Texas Medical Galveston and Donald Wright, PhD, University of Medicine and Dentistry …

Consider half life during drug detoxification

Randall S. Bock, MD

Medications

August 30, 2011

A young man on my sobriety-based detox program (only after showing positive for opiates) admitted to heroin-usage, but hedged the matter saying it was “5 days ago.” His implicit presumption was that an isolated episode, days ago — compared to continuous, more recent, heroin-usage — would lessen the likelihood of his getting kicked off the program.

Is his story of “no heroin [ingestion] in the last five days,” likely, the whole …

The expensive progression of pill crushing technology

Gina, RN

Medications

August 29, 2011

We have to crush pills sometimes. Either the patient (through aversion or physical limitation from stroke) can’t swallow whole pills so we crush them and put them in applesauce, or the patient gets their pills through a tube, so we crush them and dissolve them in water.

When I started nursing, we had a mortar and pestle.

Anyway, this is what we used …

The ethics of being on a pharmaceutical advisory board

David B. Nash, MD, MBA

Medications

August 27, 2011

While diligently perusing a stack of unread journals, a piece in the July 25, 2011 issue of Modern Healthcare caught my attention.

Titled “What’s the Agenda?” this special report deftly navigated the murky waters of “physician participation on advisory boards” and managed to present an accurate appraisal of the issues.

Here is a brief recap.

Back in the days before “medical ethics” issues were commonplace, pharmaceutical and medical device manufacturers were accustomed …

Fair balance gives natural pills and supplements an advantage

Stewart Segal, MD

Medications

August 26, 2011

The reality is that my job constantly challenges my sanity. Sometimes, I just want to scream.

Patient: “Doc, I don’t want to put any poisons in my body! Isn’t there a ‘natural’ remedy I can take?”

Doc: “No, I want you to take my poison! I haven’t poisoned my quota of patients this month and need to reach my goal.”

Poisoning patients really isn’t good for business. Why would a patient believe that …

Personal responsibility is needed to treat drug addiction

Randall S. Bock, MD

Patient

August 24, 2011

A 44-year-old man came to my office to begin Suboxone in hopes of stopping his injecting heroin. He was raised well by married parents, whose other four children have not indulged in narcotics.

He lives with a friend, unable to contribute to rent while “not working” yet somehow he affords $50 per day for narcotics through (self-admitted) hustling (comprising: working as one tentacle of the drug-dealers’ network, shoplifting, borrowing with no …

Getting insurance to cover a test requires guessing the diagnosis

Deep Ramachandran, MD

Physician

August 8, 2011

We had an interesting dilemma in the office. You see, being pulmonologists we treat people with asthma, and one of the more useful drugs we have in the ammunition belt is a medication called omalizumab (Xolair).

Among patients in whom it’s indicated, particularly those with severe allergic asthma, the effects can be dramatic and life altering. The problem with this drug is the cost. Actually also the administration. And the anaphylaxis. Not to mention all the …

A cream to fight obesity is being ignored

George Lundberg, MD

Medications

August 7, 2011

Do you, or many of your patients, have a little more belly fat around your and their middle than you and they would like? Me, too.

Turns out that there are two decent published studies from reputable places that report that a person may rub a cream on their skin over the fat spots and make the fat go away.

Wow, what a deal.

The first study addresses fat thighs, with each …

Should Lipitor go OTC? A cardiologist says yes, an internist says no

Kevin Pho, MD

KevinMD

August 4, 2011

With the patent for Lipitor expiring, Pfizer is considering selling an OTC version of the statin.

It’s generated a firestorm of debate, with doctors speculating on the impact for patients.

According to Pharmalot, “an OTC version would allow Pfizer to capture some of the sales that will be lost when the Lipitor patent expires in November. In fact, Pfizer execs recently changed …

Patients lose when insurers cut reimbursement for immunizations

Stewart Segal, MD

Medications

August 3, 2011

I recently received a declaration of war from one of the major healthcare insurers. Not happy with its current record profits, this insurer has decided to reduce its reimbursement on immunizations and injectable medications by 40%. I do not have a 40% margin on immunizations and injectable medications. My margin is at most 10%. This means that with a 40% reduction, I will have to pay at least 30% …

Who to blame in fatal medication overdoses

Emily Gibson, MD

Medications

July 31, 2011

There was news of yet another high profile death from an uncertain cause in a star with addiction history. Media accounts included reference to the “27 club” — a lengthy list of famous artists who have perished by their own hand, often unintentionally, at the age of twenty seven.

The reality is that too many fatal overdoses responsible for the deaths of the famous and not-so-famous are from medications …

Tobacco cigarettes should be sold only in pharmacies to people with a permit

George Lundberg, MD

Medications

July 31, 2011

I like Iceland. It is a really neat place; great people; terrific scenery; lively nightlife; surprisingly temperate climate, considering the latitude, thanks to the Gulf Stream.

Of course, it is true that some of the Iceland bankers, poorly regulated and without scruples, were even more predatory than many of the American Wall Street investment bankers, taking the money and running to lead a pack of nations into international fiscal calamity, a …

When to use a new technology and when to die with dignity

Stephen C. Schimpff, MD

Physician

July 29, 2011

American medicine overuses its technologies and innovation triumphs and way underutilizes old fashioned compassion, discussion and good common sense.

Over the past twelve weeks I have given weekly updates of medical megatrends in the fields of genomics, stem cells, transplantation and vaccines. These advances are the representation of innovations and entrepreneurship in biological, computer and engineering science. They are exciting advances and offer promise of hope …

How dabigatran is an atrial fibrillation paradigm shift

John Mandrola, MD

Medications

July 28, 2011

My iPhone vibrated with an urgent message that read: “Please call … the INR on your atrial fibrillation patient scheduled for cardioversion is too low. He is on that new blood thinner, Pradaxa. What do you want to do?”

I responded, sounding like an expert: “It’s ok. Pradaxa thins the blood adequately, it just doesn’t change the INR.”

She astutely responded, “How do know the blood is thin? What if …

Celebrity endorsements of prescription drugs

Richard Meyer

Medications

July 27, 2011

Boniva continues to use Sally Field as a celebrity spokesperson for their product but as John Mack pointed out, should any prescription drugs be paying celebrities to endorse their products? Well, according to an Ace Metrix study the answer to that is “probably no.”

The Ace Metrix study found of more than 2,600 ads that celebrity ads do not perform any better than non-celebrity ads and in some case …