Prescriptions and the bottom line are a troubling mix

People's Pharmacy

October 28, 1997|By Joe Graedon and Teresa Graedon, Ph.D. | Joe Graedon and Teresa Graedon, Ph.D.,SPECIAL TO THE SUN

Has your prescription been changed recently even though the old drug was working just fine? If so, you may be an unwitting victim of a war being waged in the pharmacy.

Once upon a time, doctors prescribed medicine without interference. They tried to use their clinical experience and judgment to make the best decision for the patient.

Nowadays, many doctors are finding that their choices are limited by the patient's insurance plan.

For years, John took Zantac for severe heartburn brought on by a hiatal hernia. It worked to control the condition and he experienced no side effects.

Then one day his managed care company decided it needed to save money on his prescription. It asked his doctor to switch John to a different drug, cimetidine, the generic form of Tagamet. The doctor agreed, and John's troubles began.

In less than two weeks, John landed in the hospital close to death with an inflammation of the pancreas. It took him months to recover.

But even after he got out of the hospital and his doctors confirmed that cimetidine had caused this rare problem, his insurance company wouldn't cover Zantac. John paid for his next prescription out of his own pocket.

Switching people from expensive medicines to cheaper alternatives is becoming commonplace. This would not be a bad thing if it were always based on the patients' best interests. But more and more, the decisions seem driven by bottom-line considerations at insurance companies.

Drug companies are also getting into the act. Some are paying big money to have managed care companies give them preferred treatment.

In other cases, manufacturers have gone straight to pharmacists and rewarded them with rebates if they convince doctors to switch their prescriptions.

Hospitals are not immune. When they get an especially good deal from one company, they may encourage their doctors to prescribe that drug in preference to other, similar medicines. While this may not be a problem in most cases, in some instances allergies or sensitivity may make such a switch disastrous.

The trouble is that people who know nothing about you or your special medical history may determine which medications you will take.

Many physicians are distressed at the increasing interference in their decision-making. Some admit that they now resent getting calls from pharmacists trying to influence their choice of medicine.

Patients are also becoming upset. Switching from one antidepressant or blood pressure pill to a cheaper alternative can lead to unexpected consequences.

We wonder whether the decision to go from a medication that has worked for years to another, less expensive drug might sometimes be penny wise and pound foolish.

It is time for physicians, pharmacists and patients to unite in their battle with the bean counters.

Saving money is important, but let us not sacrifice health to the bottom line.

My pharmacist suggested switching from Prilosec to Axid. I'm reluctant to do that. My doctor said it might be all right, but she didn't sound convinced. What do you think?

Prilosec (omeprazole) differs significantly from Axid (nizatidine).

Such a switch should be undertaken only if your doctor believes it is best for you.

I read in your "People's Pharmacy" book that aspirin might interfere with the benefits of Vasotec.

When I asked about this my doctor and druggist seemed surprised and annoyed.

My doctor has me on both aspirin and Vasotec for my heart. If aspirin is a problem, should I stop taking it? But isn't it supposed to be good for the heart?

I'm so confused, I don't know what to do.

Please help me.

You are not the only one who is confused. For years, we have been concerned about the potential interaction between aspirin and Vasotec (enalapril). But there is no information about it in the official labeling.

Do not stop taking either aspirin or Vasotec except under doctor's orders. Both are life-saving medications, with aspirin as crucial as the prescription drug.

An earlier study showed that aspirin could reduce some of Vasotec's benefit, and a recent article in the American Journal of Cardiology (1997;79: 115-119) showed that the combination of aspirin and Vasotec was less effective than either drug alone.

Please tell us about a new drug, Aricept, that was recently prescribed for my wife.

Aricept (donepezil) is being prescribed for the treatment of Alzheimer's disease. It helps, but is not a cure.

Side effects may include nausea, vomiting, diarrhea, insomnia or fatigue.

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their latest book is "The People's Pharmacy: Completely New and Revised" (St. Martin's Press).

King Features Syndicate

Pub Date: 10/28/97

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