Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina


Doubtless in this election year we shall hear many suggestions about how government can control the cost of medicine - but don't hold your breath before any effective solutions are achieved. The real question is - what can you yourself do to reduce the costs of the medicine you take, given the present circumstances.

While new medicine is often very effective, the other side of the coin is that it is often quite expensive ?- few will disagree, especially after paying their bills. The Harvard Health Letter of February 2000 (volume 25, No. 4) discusses a number of ways to cut the pill bill.

Tell your doctor that you wish to lower your medication costs, if possible. He may know of some other medication that could be substituted and that is equally effective. It's worth asking. There often are a number of possibilities in managing any given situation.

The use of generics is worth considering. The cost of a generic is less than a brand name. However, you must be sure that there's no loss of effectiveness. In the field of cardiology there is one notable example ?- that is the use of digitalis. Digoxin is a generic that is absorbed erratically and thus its effect is variable and it may be sub optimal and possibly dangerous. On the other hand, Lanoxin is a brand?name, is well absorbed and very effective. This medicine is used for various cardiac maladies and misuse should be avoided. While Lanoxin does cost more, it is not by a large amount.

To save money you may be willing to take medicine two or three times a day, rather than the single long acting pill that you may presently be taking. This does save money but it is a double?edged sword. You must be a very reliable patient and be certain that you take medication as prescribed. Compliance studies have shown that when a medication is prescribed once a day the patient will take it accurately about 90 percent of the time. Whereas, when a medication is prescribed two or three times a day the compliance rate is much less. So you must be a very precise individual before even considering this option.

In any event, one should be certain to take the medication (whether once a day or three times a day) exactly as instructed. Failure to adhere to the program may give misleading information to the doctor and he may then prescribe additional medicine. For example, if one takes high blood pressure medication and fails to take a few doses and then sees the doctor the blood pressure may be high again and the doctor prescribes an increase in the medicine.

Shop around. It's worth comparing the prices at different drugstores or even on the Internet. This can be especially helpful if one is taking medicine for a long period of time. But it must be a valid comparison -- sometimes the prices may even be higher on the Internet or with a mail?order pharmacy.

Pill splitting. In general this is not recommended - the "official" recommendation on this practice is negative because it may not be done properly: the patient may become confused or errors may be made. But it is true that some doctors recommend it. For example, I know of a colleague who routinely prescribes Viagra as a 50 milligram pill; since there is a line on the pill and it can be cut in half. Thus, if half the pill is effective then there is a considerable saving for the patient since the price of a 50 milligram pill is only slightly higher than that of a 25 milligram pill.

But before using any of these measures you should discuss the situation with your physician -- Hippocrates cautioned doctors "above all do no harm."

The advice provided on this website is intended to be general in nature and should not be relied upon for specific treatment. If you need personal medical attention please contact your physician.

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