In changing health care world, you’ve gotta help yourself | Column

Here’s a revelation: the picture of healthcare is changing. Modern advances in medicine have brought about a quicker and more accurate diagnosis of many of the diseases and health-related problems that we face each day.

Here’s a revelation: the picture of healthcare is changing. Modern advances in medicine have brought about a quicker and more accurate diagnosis of many of the diseases and health-related problems that we face each day.

Obviously, this is a very good thing. However, Marcus Welby is no longer alive and well. The days of leisurely doctor visits are pretty much behind us, replaced by insurance-driven “fast food medicine.” Providers (doctors, pharmacists, nurses, etc.) are all expected to do more in less time for lower reimbursements. In my opinion, when the corporate insurance three-piece suits make all the decisions then managed care often translates to mangled care. So how do we survive in this new environment? Here are a few tips:

1. Be the squeaky wheel. Become your own advocate, whether it is fighting to get a procedure covered by your insurance company or finding out what drugs your insurance covers. You can’t expect your providers to do it all for you. We simply don’t have enough hours in the day.

2. Concerning drugs – assume that your insurance prefers generic medications. Repeat this mantra: “Name brand = EXPENSIVE” (and therefore probably incurs more cost to you, either through a higher co-pay or no coverage). Ask your doctor if there is a generic option for your treatment.

3. Be organized – your providers (doctors, pharmacists, etc.) are all squeezed for time, so it is helpful if you have all your requests and questions written down so that they can be covered in a concise manner.

4. Plan ahead – requests for procedures, refills, and questions roll in “en masse.” If everyone needs it “in 10 minutes,” there is no way everyone can be accommodated. Except for emergencies, give your providers some time to deal with your requests.

5. Don’t kill the messenger – no one likes delivering or receiving bad news. Please realize that if your doctor or pharmacist tells you that your insurance won’t cover something, it is not the provider’s fault.

Sometimes much of what goes on in healthcare is out of the public eye. I have seen more drug recalls in the past year than at any other time in my 35 years in pharmacy. In the past 30 days we have received almost 50 drug recall notices. If this doesn’t scare you, it should. The recalls have ranged from inconsequential to potentially life-threatening problems and have covered areas from regional to national in their scope. Recalled medications have caused huge shortages of entire classes of drugs, as was recently experienced with the national digoxin recall. As of the submission of this story (mid-June), we are still experiencing nationwide shortages of generic digoxin with no relief in sight.

And another troubling thought: many of the raw materials for drugs come from overseas. The recent earthquakes in China might well impact the flow of raw materials to drug manufacturing plants located elsewhere. We may see further shortages and delays in production. One remedy is to keep an extra month’s supply of all your maintenance medication. Many insurers limit the frequency of refills for medication and do not allow prescription refills to be processed too early. However, with a few exceptions, most insurers will allow a refill to be processed when 75 percent of your current supply is consumed. That means if you normally obtain a month’s worth of medicine with each fill, you can refill your prescription when you have about a week’s supply remaining. If you set that extra week’s supply aside and continue to do that every month for four months, you will accumulate an extra month’s worth of medication to keep on hand for emergencies. At that point we recommend that you rotate the emergency supply into use and set aside the most current month’s refill for the emergency supply; by doing that you will always have fresh stock as your back-up supply. In a pinch you can always buy an extra month’s worth of medication off your insurance, but with today’s name brand medication, that could be a very costly proposition.

One final frightening reality: rural healthcare is in dire straights. Shrinking margins, problems with staffing, big city dollars, and long hours all conspire against rural healthcare providers. Don’t expect your rural providers to be here when you need them if you don’t support them on an ongoing basis. No rural business can survive on handling emergencies alone. It’s the day-to-day support that keeps the doors open. As the old adage goes, “use it or lose it.” I realize this is a bit more dour than my usual columns, but please, don’t kill the messenger.