Getting Medicine For Less
By Kerry Hook

One of the best ways to maintain your health is to take
your medicine exactly as your physician has prescribed.  
Frequently, people are tempted to cut back on their
dose, or put off filling their prescriptions when they are
short on funds.   While this may make sense financially,
physically it can be a disaster.

Many medicines must reach a certain, critical,
therapeutic level in your bloodstream before they begin
to work and this can only happen when there is a
constant, steady dose that is taken repeatedly over
time.  (This is why it often takes time before you start to
feel any better after you start a new medicine -- so don’t
quit any medicine before you have given it ample time
to get up to its “therapeutic dose.”   

Missing doses of medicine in order to save your pills and
make them last longer often means that the amount in
your system is drastically reduced or missing
altogether.  This is because some medicines have a
particularly short half-life - - some far shorter than
others.  Half-life refers to how long a medicine will stay
in your body before it is all used up, broken down or
washed out of your system.   The half-life of medicines
vary both across the different types of medicines and
within any given group of medicines.  What this means is
that if they are very quick to get out of your system
(short half-life), and you skip a dose, then the medicine
cannot work because is no longer present or has
dropped below too far below its therapeutic level to
work.  

For example, within the group of  anti-depressants,
Prozac has a relatively long half-life, whereas Effexor
has a very, very short half-life. This means that missing
one dose of Prozac will cause fewer problems than
missing one dose of Effexor but you should NOT skip a
dose of either medication because both will work better
for you if they are at the proper level in your
bloodstream.  

Skipping doses of medicine can increase the chances of
your experiencing nasty side effects because your body
never gets adjusted to the medicine.  Often people
mistakenly think this means that their body was
“addicted” to the medicine, but it does not mean that.  
Think of it like pulling the carpet out from under your
feet – no one’s body takes too kindly to that – so keep
your doses of medicine stable and you will feel much
better.

Talk to your doctor. If you are finding yourself skipping
doses to save money, be sure to ask how this will affect
your health.  Explain that you are having difficulty taking
all of the medicine because of financial constraints.   
Most physicians genuinely want to help their patients and
will happily help you find solutions because they know
that you will get better much more quickly if you take
your medicine each and every day.

Being forthright in this regard is best because it may also
foster a better relationship with your doctor.  
Sometimes, physicians will label a patient as
“noncompliant” if they aren’t taking medicine the way it  
was prescribed.  If a physician concludes that you are pat
“noncompliant” they tend to believe that you are really
not that interested in getting better and it is a waste of
their time to try to help.  If there is a good reason (low
funds) that you are not taking your medicine it is in your
best interest to make sure that the doctor understands
the reason.


Most pharmaceutical companies will samples of their
product with physicians as part of their product
promotion.  Samples may be a good source to
supplement your medicine on an infrequent basis, but
don’t expect the physician to be able to provide you with
samples at every visit.  Samples aren't meant to be
your main source of medicine.  

It is almost always advisable to ask for samples if you
are just beginning a new medicine.  This is quite
justifiable because there is no sense filling a full
prescription only to discover that you cannot physically
tolerate it.  Samples can help you figure out your react
physical reaction without having to pay for a full months
prescription.  

If your physician doesn’t have any samples (and they do
run out), you may need to think of other options.  

I do NOT  recommend pill-splitting as a good way to
save money, though you may  have seen this advice on
some other websites that are geared to seniors living on
a limited budget.   The American Medical Association has
taken the position that pill splitting is not an advisable
practice.  Pill splitting has simply not been studied
thoroughly enough to determine if indeed exactly one
half of a perfectly split pill really does contain exactly
half of the intended dose.  It may, but it may not - - no
one can say with any certainty because this has not been
extensively studied.  


So where did anyone get the idea that this was a good
idea?  The idea stemmed from the historical practice of
pill splitting in order to get a pediatric dose.   Typically
this occurred only because no pill existed with a dose low
enough for a small child.  Most often this occurs when a
drug is used for an “off label use” – one that the
manufacturer did not intend and does not have FDA
approval for.  Nevertheless, “off label” use can, in some
situations provide effective care, but its practice arose
because of an unaddressed need in a particular set of
circumstances.  As with most things in life, that doesn’t
mean it should be adopted by everyone.  

Some medicines, particularly those taken by seniors can
become lethal at an incorrect dose.  (Coumadin is one
such medicine).  Keep in mind that when any pill is split,
the split may be uneven.  The variance between the
larger portion and the smaller portion may be as great
as  40%.   There is a very small difference between the
dose at which Coumadin is effective and the one where it
becomes lethal.   Certainly, perfectly even pill splitting
can be very difficult if you are inexperienced, have poor
vision or  significant arthritis - - all things that affect us
more as we age.   

Remember, some medicines  cannot be split because
they are a capsule.   NEVER attempt to split the contents
of capsule in half.  Some pills have a protective coating
or are time-released and should never be split.  There
are many reasons that you should not split pills, so we
specifically do not recommend pill splitting as a way to
save money.

There are much safer and therefore BETTER ways to
save money on your medicine.

Today, we’ll focus on how to investigate the possibility of
getting your medicine for free.

It is a little known fact that many of the roughly 160
drug companies give away a considerable amount of
medicine (free of charge) to those on a limited budget.   
(usually defined as twice the poverty level as defined by
the Federal Government).  These programs are called,
“Patient Assistance Program” (also known as PAPs).  No
two programs have the same rules (age or income caps)
or offer the same medicines.  Not all medicines are
covered, but it is worth your while to investigate the
possibilities.  

Generally, if you are a single, the income cap is around
$19,000, but I have seen programs that list a cap of
$23,925 (higher in Alaska and Hawaii).  Family income
caps are typically in the range of $38,000, but I have
seen these as high as $60,000.  These qualifying
incomes vary because each pharmaceutical company
has its own unique rules for qualifying for their
program.  (These programs are not government
programs, they are developed and run by the drug
companies themselves.)

If over 5 million people qualified in 2002 for 14.1 million
prescriptions with an estimated value of $2.3 billion,
then you may qualify too.  So, how do you access PAPs
to find out if you qualify?

By phone:  Call the Pharmaceutical Manufacturer's
Association at 1-800-762-4636.  They have a list of all
PAPs, as well as contact and qualifying information.  

Online:  The Pharmaceutical Manufacturers Association
has a very nice website.  It is easy to use and once you
provide some very basic information, it will give you a
list of matching PAPs.  (Keep in mind that they only list
information on the programs of its members.  Your
medicine may be made by a company that is not a
member.)  You can find it at:    
 The Pharmaceutical
Manufacturer's Association    

In my search for information, another site that is run by
a physician, who works in Philadelphia.  He funds his site
through the sale of manuals, but you do not have to
purchase anything to access his information.  Take your
time and read over his “NeedyMeds Article."   He has
some good tips on completing PAP forms.   His link is:

Needy Meds

Two other free sites that also have information are:  
RxAssist  and HelpingPatients

All of these are free sites and a good starting place
because they hold a wealth of information.  You could
likely find out if the maker of your medicine has a
Patient Assistance Program by simply finding their
company website and searching, but I do believe that
these sites will make things easier for you.

If you do want some more direct help, it may be worth
your while to go to the websites that charge you a fee to
fill out the paperwork.  I would only advise you do this if
you just become overwhelmed after making a concerted
effort to use the free sites.  I see little point to paying for
information that can really be received for free.  It just
takes some patience, so give yourself a bit of time to go
through the material on the free websites first.   A little
bit of perseverance can pay off in the long run.  

If you use a site that charges a fee, ask if they will
refund your money if you don’t end up qualifying for a
PAP, and don't pay a lot of money for this service.   

The site listed below does claim to provide a refund if
you do not end up qualifying for a program.  Their fee is
$5.00 and they appear legitimate.  Since I have no
personal first hand knowledge of this group, I can only
suggest that you check them out.  As always (try to use
the Better Business Bureau to investigate any business
that you are not familiar with. )  
The Medicine Program

Here is one other site that I mention, only because they
appear to have a higher cap on the qualifying income.
The Free Medicine Foundation  They will also charge you
a fee and help you complete the forms.  Once again, I
do not have direct knowledge of this group and so you
are cautioned.   My rule of thumb is that if the cost is not
too great and the risk rather small, then it may be worth
looking into.

By mail:  Contact the Cost Containment Research
Institute for a 32 page booklet called, "Free and Low
Cost Prescription Drugs. It lists 1500 medications from
85 drug companies along with their contact information.  
This brochure also has several discount mail-order
pharmacy services.   There is a $5.00 fee for the
brochure.  Address is:  Institute Fulfillment Center,
Prescription Drug Booklet, # PD-370, P.O. Box 462,
Elmira, NY  14092-0462

Download:  You may download the booklet for free
from:
Free and Low Cost Prescription Drugs

One final thought – there is very little point to asking
your doctor about these programs.  Very few physicians
even know that they exist.  The Internet is your best
source of information, precisely because these programs
can change so very quickly.  It is strange but true – the
Internet can be your best ally or your worst nightmare -
-  as we saw with the pill splitting advice –  so be
cautious.  There is no shortage of bad information on the
Internet.

In the coming months we’ll be looking at other sources
that may help lower your cost of medications (e.g.,
Medicare prescription programs, discount and  online
pharmacies - North of the Border and South of the
Border possibilities for those with incomes in excess of
the caps associated with PAPs).

Stay healthy.


Kerry Hook
Resident Researcher
Veterans and Military: Save Big on Prescription Drugs
The Frugal Retiree
drugstore.com
Value Health Card Inc.
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