I think you are. But there’s no way for you to know that. I bet even doctors are mostly guessing, based on not getting the results they thought they would with what they’ve prescribed. I’m the lucky one who actually goes into the home and sees what’s happening there as part of my job.
I’ve lost track of how many patients I’ve had in the 3 years I’ve been doing home nursing. I’ve got 10 Banker’s Boxes full of files, and each patient is maybe 1/2 an inch thick on average. So, a lot of patients. I could count the number who were “medication compliant” (meaning that they actually did take everything their doctor thought they were taking, and nothing their doctor didn’t know about) on one hand. Srsly.
If anything, Dr. House underestimates how much people lie to their doctors. I’m a lot harder to lie to. Oh, some still manage. They throw pills out at the correct rate per week instead of taking them and think I don’t know. Sometimes I really am fooled. But I just try to make it more inconvenient to play those games than it is to take their meds. And at the end of the day, it ain’t me they’re cheating, so I can only care so much. I can’t care more than they do.
Advair, if you’re paying out of pocket, costs around $300/month. Holy crap! Luckily I need it once in a blue moon for a flare-up and rarely need my albuterol inhaler, provided I take my nice, cheap OTC allergy meds.
I’m glad it’s still prescription, so that my insurance covers it. Unlike Prilosec, which even if my doctor prescribes it, the insurance won’t pay. (How screwed up is the US health care system anyway? If I don’t take this stuff regularly, there’s a good chance I’ll develop cancer. They should pay me to take it! PS: I have all or nearly all of the specific conditions that are precursors to cancer, not merely a little heartburn.)
Please tell me where you get it. I just found out that mine is $1000 for a refill. Perhaps that’s a 3 month supply, though. Also, I take the “mid-grade” dosage.
Advair? Advair is a combination long-acting bronchodilator and steroid which generally should be reserved for those inividuals who are not well controlled with every day use of a strong daily stand-alone steroid. It is not a rescue med. Using it as you do is not its usual advised place.
There are cheaper (and safer) preventative meds. Here’s a review of costs for the inhaled steroids. There are options there that would cost a fraction of that. And if by mouth Singulair is a reasonable choice (which might also decrease your need for other allergy meds) Costco has been priced at only $27 a month.
Don’t be afraid to bring up cost concerns with your doctor and don’t be shy about calling some pharmacies to get some real world out of pocket expenses for different options before that discussion.
That’s not what I do. Once every few years, I have an asthma flare-up, usually after an upper respiratory infection. I don’t need any asthma meds at all, rescue or otherwise, the vast majority of the time. But when I have a flare-up, my doctor usually puts me on Advair for a month or two, along with a short course (a few days) of oral steroids. It works for me.
I literally can’t remember the last time I needed to use my albuterol inhaler. Benadryl and/or Claritin (generics) work fine for my allergies (which are not just respiratory) for pennies a day.
I’m guessing that’s a 3-month supply. I got my last U.S. refill at Costco, and it was around $280 for a 30-day supply (with a small BCBS discount) because I hadn’t hit my annual deductible yet.
Excellent advice. Reason being, there is not a “price” for Albuterol, or Advair or anything else prescription. There are hundreds of insurance plans in your area, and they all make a person pay something different out of pocket. Even without insurance, the price difference from one pharmacy to the next might be a whole decimal point. Your doctor has absolutely no way to know what any medication will cost you without calling a bunch of pharmacies with your payment information, and that’s just not asking a reasonable thing of him/her. That’s your responsibility.
However, one problem most of my patients have with that is that they don’t know what the likely options will be, so they don’t know what to price out until *after *they’ve spoken with the doctor. I generally suggest they go in asking the doctor for two or three recommendations, in descending order of medical preference. Then they (or I, or a family member) can do some phone work to get prices. Then the patient can call the office tell the doctor what their choice is. Almost always, the office will be able to fax the selected prescription to the pharmacy for them then.
Also, don’t assume that because your pharmacy is the cheapest for one drug, it’s cheapest overall. It doesn’t always work out that way. While it’s safest to get all your drugs from one pharmacy, where one system is checking everything you take for health risks and interactions…that’s not always the best financial decision. If money is a real concern, I’d rather people get their medicines at multiple pharmacies, if that means they can afford all of them instead of just some of them. Just be very sure that your primary care doctor has a complete, accurate, up to date list, so that someone who knows stuff is aware off ALL your medications.
Medication costs can be a significant barrier to care. Do talk to your doctor; they may be able to help w/ samples, discount cards, or choose an older, lower cost, medication for you.
Also check out GoodRx.com (also w/ apps for iPhone & Android)
They can tell you where to go locally for the lowest cost of a given med, find manufacturer coupons, check for generics, and show comparable meds.
My beloved MIL almost brags of her policy of telling the doctor the combination of facts she thinks will deliver the result she wants. Usually that’s a diagnosis that nothing is wrong & she won’t need any meds.
She’s 89 and her resting BP is north of 170/140 most days. And she doesn’t have any prescribed routine BP meds. So in some sense her policy’s been working; she’s still alive and darn few of her HS classmates are. I just hope when she finally does burst an artery it kills her cleanly. Paradoxically, crippling stroke is her biggest fear.
With this in mind, the medical director of a major insurance company actually set all asthma medications a $0 co-pay for a year for one group of patients.
At the end of the year, the group with the $0 copay had no asthma-related ER visits.
I wish more insurance companies would think this way, but that shit won’t happen, even with data to back it up.
Did you read the thread? Being around for a long time doesn’t automatically deem a medication to be safe for OTC sales. Would you advocate the same for digoxin which has been used in some form since at least the 1700s and has one of the narrowest therapeutic ranges of any medication used today?
I have lived with chronic asthma for 40 years and the answer Whynot gave in #18 is spot on. I take beclometasone twice daily and salbutamol as required and the two inhalers are always in my pocket.
It is certainly easy to forget to take a medication that has no apparent immediate effect and I have missed a dose many times. Since I am in the UK, the cost has no impact. I also agree that I have understated my use of the reliever when asked - I think that this is similar to being asked how many units of alcohol you take, and I am sure that most doctors will automatically add 50%. In any case, they can easily check.
It is true that I am supposed to be reviewed at least annually. These days I don’t even have to go to the surgery - I order the scrip online, they it send online to the pharmacy of my choice and I call in a couple of days later to collect it. I could have it delivered, but I don’t like to take liberties as I feel that (free) service is for the housebound.
Asthma treatment has come a long way since my mother suffered from it in the 40s and 50s. I have often shocked doctors when I relate that I, as a young teenager, used to go to the chemist to collect her prescription for a bottle of 100 half-grain ephedrine.
Cynical statements happen from longtime health insurance employees who’ve seen what the companies will do to make money, and how short-sighted the leaders of said companies can be.
Yes, I saw the explanation of some of the dangers of extreme albuterol overuse.
I’d missed the edit window, and then went to bed.
A hint from a fellow asthmatic: I used to forget one or both of my maintenance inhaler doses until I started to keep the inhaler (I use Advair now) by my toothbrush and toothpaste. Now I use it AM and PM before I brush my teeth. Bonus: you don’t forget to rinse your mouth after using the steroid spray!
Great idea! I’ll put it there tonight, since I keep forgetting to use it.
One more data point on how people like me need to do a better job of looking at the cost of medications: I just got prescription renewals for both albuterol and for Flovent…somehow the albuterol was $2, and the Flovent was $90, which is kind of the reverse of what you hope for if you think pricing should be based on behavioral incentives. In any case, I’m assuming that the next time I have to renew the Flovent I’ll be able to figure out something smarter.
I wish there was a epinephrine inhaler still available even if it was not OTC, because Primatene Mist was the only rescue inhaler that ever worked for me. Trying to switch to albuterol put me in the ER for the first time for asthma.
The only solution now is the Asthmanephrin mini nebulizer and liquid refills that is troublesome to use and clean.
I have asthma that came on suddenly and rarely but severely, Claritin daily has almost eliminated the attacks but I still keep a old PM handy for a possible emergency.
Statements like this, mentioning multiple canisters of rescue inhaler per month, remind that my asthma is mild - I don’t go through one canister in an entire year, much less a month, and invariably they expire before I finish them.
Then again, for the most part I keep the allergies and asthma under control, and when I can’t I go to a doctor.
For the medical professionals - when I get upper respiratory infections (just getting over a head cold from hell right now, as a matter of fact) I am always concerned about asthma exacerbation. They don’t always happen (thank goodness!) but they certainly can (and on a couple occasions have). The questions are:
If I’m not having any worsening asthma symptoms should I be on something preventative anyway? Or, just leave well enough alone? What’s the current thinking on that? (My inclination is not to add/increase medications unless symptoms warrant, but I could be wrong in this instance.)
At what point during a temporary and transient illness should one get something? Before symptoms start (wait, I just asked that, didn’t I?) When you have to take one hit a day? In the past I’ve had docs willing to put my on oral steroids at the drop of a hat and others saying it was OK to use the albuterol twice a day for up to a week. This hasn’t come up for quite awhile (thank goodness) so I expect the answer today is different than it was 20 years ago. The last time I asked my current doc about this was the last time I had the genuine flu (yay, 103 degree fever) but since that bought of the flu didn’t annoy my asthma it was sort of moot point. (Please do not tell me about flu shots, I’m allergic to them, more’s the pity, because otherwise I’d be first in line to get one. I rely on obsessive hand washing and herd immunity, and when I get flu I go to the doctor ASAP.)
But there’s no way for you to know that. I bet even doctors are mostly guessing, based on not getting the results they thought they would with what they’ve prescribed. I’m the lucky one who actually goes into the home and sees what’s happening there as part of my job.