There has been a surge in 90-day supply prescriptions with refills for medications. The major factor in all of this is the great cost-savings from the patients’ prescription drug plan that benefit the patients’ pocketbook. After all, why pay 3 copayments for 3 months when you can pay 2 copayments and get the third for free? Seems like a win-win situation to me. The insurance company wins in lowering their costs and the patient wins for saving some money every quarter.

However, there are some things that the patient and physician need to be mindful of: a) Missed monitoring of medical conditions if the patient is seen yearly, and b) Medication changes can take place due to disease progression.

Both of these situations can cause undue financial burden if both the patient and primary care provider are not focused on them. Here’s how:

Missed monitoring of medical conditions: Since a patient gets a 90 days’ supply with refills up to a year, the physician is assuming that the medical condition is stable with minor changes, and that the patient is reliable enough to take the medication as prescribed. In reality, while some patients are going to be “stable” in the short term, there are medical conditions that worsen over the course of a year. By the time the patient returns for their yearly physical, the medication prescribed a year earlier may just be enough to barely maintain physiological control. As proof, I have seen diabetics who have tested with A1C’s of 8 -10 and have had no change in their medications for years. When questioned, I hear patients tell me that their physician “knows” and is “watching it”. If this is correct, then the patient needs to know WHEN the physician would be modifying his treatment plan. To correct for this yearly monitoring visit, patients with chronic conditions need to be monitored (self or care-giver) on a bi-weekly or monthly basis to see if their condition worsens. If there is deterioration, then a physician’s visit is needed.

In medication changes, patients would have ordered another 3-month supply from the pharmacy, only to find out on their next physician’s visit, that their therapy has been changed to reflect disease progression. Since the patient assumed that they would be on the same dose as before, they went ahead and ordered the medication and paid for it. If the dose, drug, or treatment plans changes, the patient would lose their money.. not a good thing.

To correct for this waste, your next physical exam should be planned to be within the last few days of your medication. This way, if the physician was to change meds, doses, etc., the timing of the medication change will coincide with the next medication fill.

The “take-home” message here is to enlighten you about possible pitfalls and educate you on how to avoid them should they come up.

Until next time, stay well.

Dion