I had been watching my mother’s prescription-drug bills soar past $300 a month. I was in tears the first time her bill hit $500. But nothing had prepared me for the $500 monthly cost of this one new drug, prescribed by a specialist in an attempt to reduce daytime lethargy. If it were not for the savvy pharmacist and an understanding nurse, the cost of my mother’s prescriptions would have immediately doubled.
I’m not anti-doctors, and I have good relationships with mine and my mother’s. But what on earth could that specialist have been thinking? My mother has no prescription insurance. How could her doctor prescribe an elective pill that could cost $6,000 a year and is only a possible remedy without first discussing the options with her family?
The cost of health care for seniors was a hot topic during the last presidential campaign. The candidates promised to help the elderly by fighting for prescription-drug coverage under Medicare. George Bush said the issue would be one of his administration’s priorities. Al Gore stated that all seniors should have access to the new miracle drugs.
Those are important points. But we seem to be overlooking something here. The problem is not just the horrendous cost of prescription drugs. Nor is it solely the lack of insurance coverage to pay these costs. The missing factor appears to be that many doctors do not know the cost of the medications they are prescribing, nor do they attempt to find out. In the meantime, drug companies pour billions into promoting their “very latest cures” to the medical profession, and send their reps out to chat up doctors and pitch the new drugs. But is the price of these miracle drugs ever discussed?
Governor Bush cited a puzzling number in a speech last September when he said the “majority of seniors use less than $576 in prescription drugs a year.” Perhaps that is the case for the “young” old. But I haven’t heard about too many people in their 80s or beyond with monthly prescription bills averaging $48.
For my mother, the long slide from self-sufficiency to dependence began in her mid-80s when Meals on Wheels replaced home cooking. A few years later she fell and broke three ribs. Maintaining an apartment became too difficult for her, so I started driving to Baltimore each weekend to attend to her chores. But she fell twice more, breaking her pelvis and then her hip. For her, returning home was no longer an option.
While still living on her own, my mother saw various doctors for a variety of problems–some severe, some not–and each one prescribed medication. But the doctors weren’t communicating with each other, so no one was coordinating her treatment or her drugs. Sometimes the meds didn’t work or caused unacceptable side effects, leaving my mother with bottles of expensive medicine she couldn’t use but still had to pay for. More than once, I found her lying in bed in an overmedicated state.
Clearly my mother needed care tailored for her age group. We selected the Johns Hopkins outpatient geriatric program. One of the first things the geriatrician did was cut back on her meds. When he saw one of my mother’s bills for prior treatment, he called the numbers “staggering.” Both my mother and I were relieved to have finally found the right medical care and a doctor who was concerned about runaway prescription costs.
Some of my mother’s other doctors have become sensitive to the cost issue since it was pointed out to them, but few seem to consider it when they are first prescribing. On the other hand, I’ve seen doctors who have overreacted by eliminating expensive medicine from consideration, even when it’s warranted. Sometimes only a costly drug can do the job, but if there is a lower-priced version that will accomplish the desired result, why not prescribe it?
Generally, older drugs cost less than the new ones, but some doctors forget about the old standbys in light of all the hype from the drug companies. And why not provide the option of starting out with a small number of pills to see if the medicine actually works before the patient buys 90 pills and uses three?
As for my mother’s continuing fatigue, the nurse suggested trying caffeine–a cup of coffee in the morning and a Coke at lunch. I don’t know yet if this will work, but it’s worth trying at least as much as a new $500 prescription.
Rx for doctors: please check the costs.
