To what extent is the doctor responsible for this (long)

My husband has had gout in the past, localized mostly to one or two joints on one foot. When he had the symptoms, the pain kept him from being able to walk. Last year, our doctor had x-rays done and said that there is some joint damage and that he should consider starting to take a medication which would prevent future attacks and also prevent more joint damage. He said the medicine, once started, has to be taken forever; apparently if the medicine is stopped it raises the risk that gout will flare up again.

Since my husband was successfully controlling outbreaks with diet and home remedies (black cherry juice, for example) he declined this medicine at that time.

This year our doctor brought it up again, and even though he hasn’t had any gout symptoms during the year, my husband decided to go ahead with it. It turns out there are two medicines, one temporary and the permanent one. The permanent medicine costs under $20 a month which is ok. The temporary medicine is colchicine, which due to FDA policy and corporate greed costs roughly $400 per month, and he was supposed to take it for 2 months. (The doctor warned us this prescription was very expensive.) Although this medicine is not covered by our insurance (Medicare plus part F supplement), we could afford this, but we are not happy. We filled the prescription the same day as the doctor visit and he started taking them that day.

We got a call today from the doctor, which went to voicemail as we weren’t home. My husband’s lab results (he had blood drawn the next day after the doctor visit) indicate that his kidney function apparently won’t support these medications and “if you haven’t picked up the prescriptions yet, don’t, and if you have, don’t start taking them.” In fact, when we got this message he had been taking the medications for 4 days. He has since stopped.

We haven’t been able to reach the doctor back yet, but from his message it seems likely that we have to throw out (i.e. turn in to some proper facility) $400+ worth of medicine. I should also note that the kidney function must have changed during the past year, since last year’s labs did not indicate any problem.

My question is this: considering the cost of the medicine, the lack of current symptoms, and the possibility (however remote) that the labs might indicate that the medicine would be contra-indicated, should the doctor have told us to wait until the lab results before picking up and paying for the prescription?

In my non-medical humble opinion, fuck yeah.

ETA: In my non-legal opinion, I also think your doctor owes you $400.

The doc should have checked renal function before prescribing colchicine, but he did the right thing in notifying you to discontinue it.

I would speak to him or the office manager face to face, calmy and objectively explain the situation, and be prepared to offer what you feel is a fair resolution.

(BTW, lower dose colchicine may often be prescribed for those with impaired renal funciton)

Look at it this way: your husband has just been spared two months of aggressive diarrhea.

Oh, and find out what the hell is going on with his kidneys. It is likely minor and temporary, so he may be able to use the colchicine once the kidney function is returned to normal.

mmm

Thanks. I am sort of hoping that we can use a pill splitter to use the existing pills at half the dosage (still haven’t heard from doctor again). If that proves to be not possible, and if we are never able to use the prescription, what do you think is a fair resolution? I really don’t have any idea.

Also, I was wondering if it would be possible to donate the prescription somehow, at least we could take a tax write-off on it.

The doctor absolutely should have sent your husband for lab work prior to having him start the medication. I think you and your husband absolutely need to have a conversation with him.

Some states have prescription donation programs. And yes, you may be able to deduct it from your taxes. However, drugs are only accepted in the original, unopened packaging. Pills in opened or partially used bottles won’t be accepted. Ask your pharmacist or your doctor for advice.

I figured it would be something like that, otherwise how will they know the drugs are real and un-tampered with. Oh well.

I yell at my minions for not checking renal function before prescribing a host of meds. Metformin is a big culprit, it shouldn’t be started until this is assessed. Colchicine is on the list too, but few of us prescribe it anymore since the price skyrocketed. When my dad was on it, a bottle of 90 pills went for under $5.

At least your doc did check; I see too many prescriptions handed out without proper checking. Still, it was an error on your doc’s part.

We were able to get colchicine from a Canadian mail order pharmacy for a fraction of the cost here in the US.

For those of you breathlessly waiting for an update: finally got a call from the doctor. He thinks that my husband’s kidney function problem may be caused by one of his blood pressure meds so we are reducing that by half. We have to get a new 1/3 strength prescription for the (relatively) cheap permanent gout medicine. The colchicine we are reducing to once a day from twice a day, so at least we don’t have to throw out that $400 bottle, and maybe we won’t have to buy another one.

And thanks, needscoffee, for the heads up about Canadian mail order pharmacies, which I did not think about at all. Yes, it’s available there for under $1 pill, which is still expensive but a lot better than $6+ pill.