Dear Doctor: Prescription coverage by insurance companies remains a mystery to most patients, doctors


DEAR DR. ROACH: Today was a real eye-opener for me. Two days ago I visited my doctor who prescribed me vancomycin for a digestive problem I had. Today I received a call from my usual large pharmacy that my prescription was ready for $685 for a 10 day supply.

I called my drug plan provider (I’m on Medicare with supplemental policy and prescription drug plan), and they confirmed that was the price. Then I found a website that offers coupons for prescriptions. To my amazement, a large grocery store pharmacy nearby was offering the exact same drug and quantity for $77.99 with the online coupon.

How is this possible, and does a doctor’s office usually have an idea of ​​the “normal” cost of a prescription? How about telling the patient? –BR

ANSWER: I can’t speak for all doctors, but I know most drug costs very well (my electronic system gives me a price estimate and I listen to patient feedback). However, what insurance companies will pay remains almost a complete mystery, with some of my patients receiving extremely expensive drugs (some costing 10 times or more the cost of your vancomycin) for a $10 copayment, while d others pay much more than me. expect drugs that were once very cheap.

For this reason, I tell my patients about online coupon services, such as What my patients pay with their coupons is sometimes less than their insurance co-pay. Unfortunately, drug companies know that people are willing to pay for certain drugs, so sometimes you can’t save money. Pharmaceutical company assistance plans are another source of getting prescriptions at a lower cost than insurance or retail pharmacies, if you qualify.

DEAR DR. ROACH: I’m a 75-year-old male who recently found myself unable to hold back urination most of the time. I can’t go to the bathroom soon enough or I can’t unzip my pants fast enough. I know there are supposed to be exercises for this, and I’ve tried them from time to time with mixed results. I think I’ve gone too far for them now. Interestingly, I never pee in the bed, even though the need to go wakes me up every hour or every hour and a half. I took a Flomax derivative for a while to control my prostate size, but my cardiologist took me off it due to shortness of breath, which has now subsided. Every once in a while I take one anyway, but I don’t think that would help solve the problem. Is there anything I can do? –MC

ANSWER: Urinary urgency (the feeling of needing to go right away) is common in older men, usually due to the prostate, but sometimes an overactive bladder. Infection must first be ruled out, then a drug like tamsulosin (Flomax) is often tried. If this is not well tolerated, there are other similar drugs, or a different class of drugs, to shrink the prostate, such as finasteride (Proscar). However, before going too far down the drug route, I will refer my patients to a urologist, who has the ability to test whether the prostate or the bladder is the real problem.

Pelvic floor exercises are effective for both men and women with symptoms of an overactive bladder, but first you must determine the cause of the problem (infection, prostate or bladder).

Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can send questions to [email protected] or mail to 628 Virginia Dr., Orlando, FL 32803.

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