More and more, I feel like I am spending a TON of time filling prescriptions for over-the-counter medications. (For the non-pharmacist reader, many of these are covered under medical assistance plans -- and as such, need to be processed just like a prescription medication, with all the same procedures, record-keeping, etc.) Now, this is not going to be a swipe against the "moochers" -- and believe me, I struggle with this, because I believe that the majority of people on assistance do NOT abuse it. But even fellow pharmacists who've been doing this a long time are beginning to wonder how long we can keep it up. Additionally, many of our customers on state assistance are immigrants (some might even say refugees) from other countries. Now, if a child enters this country and immediately comes down with leukemia, I'd like to think we're not going to stand there and let him die. We are better than that. But how obligated are we are to cover prescriptions for (and to stock people's medicine cabinets with) things like Tylenol? And hydrocortisone cream, and every form of vitamin, Miralax, Compound W, Colace, saline nasal spray, simethicone, Sudafed, Claritin, Eucerin, ibuprofen, calcium, iron, aspirin, Benadryl, Maalox, Milk of Magnesia, Lotrimin cream, Robitussin, artificial tears, and many MANY others -- all things that most of us purchase on our own.
Inexpensive products..... BIG EXPENSIVE HEALTH CARE machinery behind them. I think about it now every time I wade through those quality-assurance double checks of my saline nasal spray prescriptions.
We routinely have people bring us prescriptions for OTC's from a hospital emergency room. We all know the cost of an emergency room visit, and this is utter INSANITY. There needs to be a way for people to get advice on minor health issues, (ask your pharmacist, maybe?) and then be given a recommendation on what to go out and BUY for it. To be sure, there are lots of very expensive drugs and medical procedures out there that the average person cannot afford on their own. Tums is not one of them.
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There's a doctor's office close to the pharmacy I work at. Without fail, one of the doctors there prescribes the saline nasal spray, Tylenol, and Sudafed. It gets a tad annoying after awhile filling e-script after e-script of this stuff, especially when 90% of the time the patient doesn't even want it! And of course when the patients come in, they almost always have a Cheratussin script. Ugh!
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It's annoying for those of us who have Flex plans where such things used to be reimbursable when bought OTC but now need to have an Rx to be reimbursed. So in my case it's not a matter of sponging off the system but having to work within it to take full advantage of what is supposed to be a "perk." I'm sure you see plenty more of the other taking advantage though. :(
Some OTC products are not covered by our state medicaid. Many a customer has not so kindly told me that if it's not covered, they aren't paying for it. It burns me that they just took their child to the ER for free, are getting other meds for free, but refuse to fork out $2.99 for a non-covered OTC. Then I get to waste my time and the ER doctor's time trying to find something that is covered.
If the 2.00 tylenol keeps them from a repeat vist to the er for a fever, it might be the lesser of 2 evils for the taxpayers to pay for it....
@anonymous 2/2/8 @12.45
Except when that bottle of Tylenol runs out it in 4-5 days I fill ANOTHER prescription for Tylenol from a different ER visit for the same child.
True story.
Having had kids with high fevers, I've noticed that children's anti-fever medication can be pricey, especially if you have to give it round-the-clock to keep the fever down. Pedialyte isn't cheap either.
I've wondered what people on tight budgets do; I'd hate to have to choose between feeding the family and buying pedialyte, or between feeding the family and getting enough medication to keep the kid from having a fever of 105.
@ anonymous 18:17
I bottle of Tylenol or Advil are both $2.74 (generic, obviously) at my pharmacy.
The pills are even cheaper.
These are NOT by any stretch of the imagination expensive medications.
They can get expensive if huge children (heavier than me by a good 50 pounds) are still needing liquid, but using them in smaller children at the recommended dosage should last at least 5-6 days.
Teach your kids to swallow pills. (100 count Tylenol is $1.84)
And pedilyte is $3:50. Or by a giant bottle of Gatoraid for $4 and dilute that a bit.
I see this sentiment a lot - "we all buy xyz OTC meds, why can't people on Medicaid do it?"
Medicaid is for our poorest and most vulnerable citizens. They have less disposable income than most average people - in some cases, they have none at all. That's why OTC meds are covered. I'm not sure what's hard to understand about that.
I do get, though, that it's a bit silly to require a higher level of documentation and quality control just because the payment mechanism is different. That's weird.
Here's the thing, though (and I realize this is a sensitive topic) -- I don't think of 'disposable' income as what you use to buy fever medication for your child. When you have children, you accept that there are certain costs inherent in taking care of them. 'Disposable' income is used to purchase other things (we all know what they are) and unfortunately some look upon these as much more of a priority. Many, many OTC products are available as inexpensive store brands (in fact, there's a lot of competition there, which means lower prices.) I really can't think of any OTC product that is so essential to health and well-being where the cost of that product, or an alternative, is so out of reach of anyone who isn't willing to make it a priority.
For me, it's the Flex spending plans, too. Or, as I put it: "Well, I need to feed my family, so I can't get the allergy meds I take to avoid massive headaches."
When I have an rx for an OTC, if their plan doesn't pay for it 100% (including a fee) I always add a fee to the OTC cost if I'm having to process it through our system. Most people would rather just buy it OTC and that's OK with me. I just tell them right up front. No bargaining, no trying to find something covered.
The worst is when you fill it and you tell the patient of what it is and they get angry at YOU because they are upset the doctor would prescribe an over the counter medication. First, the doctor should explain what he's prescribing and second the patient shouldn't go to the doctor for a simple cough or headache when they can self medicate.
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