Keep up if you can, Jay Parkinson

Jay Parkinson has a nifty section of his blog where he details the money he has saved his patients. The timeframe spans one month (October). His total is $9,672. Pretty nice; I’ll be watching to see what else you do.

I can speak for pharmacists, technicians, and patients when I say that its really, really nice to see a doctor doing the research to find out how much drugs actually cost. I see so much healthcare inefficiency on a daily basis just as it relates to drug therapy, it makes me want to start knocking heads together. Prescribers going right for the Nexium or Prevacid without EVER trying omeprazole; Lipitor when simvastatin is just as effective and has never been tried; Lescol XL, when pravastatin has never been tried; Avodart when finasteride has never been tried. Right for the ARB when an ACEi has never been tried.

Look, I don’t give a fuck what your pet drug is. I don’t give a damn what the drug rep shoves under your nose on a weekly basis. I don’t care that you’re unaware of the top-of-mind marketing that’s being used on you without your knowledge or consent.

If it’s going to cost an elderly person on a fixed income an extra $594/year because you “like it better”, you need an ass-kicking.

And so on. I’m all for moving from one drug to another if a less expensive drug has been tried and has failed. That makes sense. But the absolute waste of money because less expensive alternatives have never been tried boggles my mind. I can truly understand why prior authorizations were invented, even if I curse them daily for wasting minutes of my precious time.

Back to the topic at hand: this time of year, people make appointments to see me, where we sit down(!), chat, review medications, and then we talk about what can be done for 2008. Most people that see me are happy with their drug therapy, except for one thing: it costs too much. The goal of their visit is to reduce the cost of their drug therapy for 2008, every single time. Without fail.

I have seen 7 people across two days. (An average appointment lasts about 45 minutes.) In that time, I have saved patients $11,831. That’s an average inefficiency of ~$1700 per person. And these are people with drug coverage. The single highest total for one person was ~$3600/year.

In the next couple of days, I’ll try to share some scenarios so you can see how much just one simple switch can save an average person.

Keep up the good work, Jay. Seriously. Pharmacists, technicians, and patients everywhere applaud your good sense and efforts.

[tags]healthcare, inefficiency[/tags]

7 thoughts on “Keep up if you can, Jay Parkinson

  1. Hey there. I’ve looked for some contact info for you and can’t find it. I want to discuss something with you privately. When you get some time, shoot me an email if you don’t mind. I’ve got a great idea….

  2. Over Thanksgiving I talked w/ my Dad about choosing a new Medicare Part D provider (sent him to your site – thanks for the link).
    He was due to see his internist to get his meds renewed.
    I told him to ask for simvastatin to replace his 5 mg Crestor – to save him a few bucks. Also thought about having him switched to lisinopril from Avapro (he’s never taken an ACE-I), but he’s kinda married to Avapro since he’s taken it for so long and it is effective. Figured could work on that one next year.
    Talked with my Dad this weekend. He got his Rxs renewed. Asked him about the simva. “Oh, Dr. B. said that if I switched I’d have to take a higher dose”, so they decided to leave him on Crestor. No s*** Sherlock was my first thought, then Arrrgghhh! So much for trying to improve the bottom line.

    (BTW – any idea why you can’t enter generic names for branded drugs at the Medicare site? It did not recognize rosuvastatin.
    And the first metoprolol listing is succinate ER – this is what my Dad chose rather than tartrate. They need some sort of alert when meds are similar as they can easily confuse a layperson)

  3. A pharmacist gets older, and gets a feel, in his own life, how drugs are prescribed: more is better, newer is better!

    I had a backache in 1982. First line according to the doctor: Clinoril.

    I had a backache in 2002. ” ” ” ” ” ”
    Celebrex;Bextra. Where’s the Clinoril?

    Surprised that a doctor ordered Clinoril for pain for a friend this year—2007—worked great, he said.

    There are excellent drugs on the market that have been off-patent for decades. They should be used. Or, should we expect somebody to try to invent a new thiazide diuretic?

  4. My mind is boggled that the doctor using a slight increase in mg of drug required as a reason to not switch boggles my mind. As though that’s even remotely valid. It’s not like he’d need a huge bump in simvastatin anyway — Crestor 5mg -> Zocor 10mg or so. If the doc had made an argument that he’d have to take it at a different time of day (HS), that might be significant depending on whether your dad is capable of remembering to do this regularly. (Is he?)

    I learned the hard way that laypeople — particularly the elderly — either forget, or misrepresent interactions with their provider without even realizing it, so what he’s said may or may not be what actually happened. And the more time that passes between the appointment and your conversation, the more skewed it becomes. (Again, this happens unintentionally because these people are unable to separate what’s important from what is not, and tend to hold onto the wrong details and consequently take home the wrong message.)

    RE: No idea why you can’t do that. When I want Toprol XL, I enter “toprol” because I absolutely want to be sure that I’m getting succ, not tartrate. We’ve had dispensing errors because of this. I guess I didn’t think of that while writing the guide because putting in the brand is just something I do without thinking if I know there’s a generic that could be easily confused. I’ll see if they have a suggestions email address.

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