Coupons help patients save money on prescriptions

Q: Today was a real eyeopener for me. Two days ago, I visited my doctor, who prescribed vancomycin for a digestive problem I was having. Today I got a call from my usual big-chain pharmacy telling me my prescription was ready at a cost of $685 for a 10day supply.

I called my drug plan provider (I am on Medicare with a supplemental policy and prescription drug program), and they confirmed that was the price. I then found a website that offers coupons for prescriptions. Much to my amazement, a nearby big-chain grocery store pharmacy 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 any idea what the “normal” cost of a prescription should be? How about giving the patient a heads-up? .

A: I can’t speak for all doctors, but I am very aware of most drug costs (my electronic system gives me a price estimate, plus I listen to feedback from patients). However, what insurance companies will pay remains almost a complete mystery, with some of my patients getting extremely expensive drugs (some costing 10 times, or more, of what your vancomycin cost) for a $10 copay, while others are paying far more than I expect for drugs that used to be very inexpensive.

For that reason, I make my patients aware of online coupon services, such as Goodrx.com. What my patients pay using their coupons is sometimes less than the copays from their insurance. Unfortunately, drug companies know that people are willing to pay for some drugs, so sometimes you can’t save any money. Pharmaceutical company assistance plans are another source of getting prescriptions for a lower cost than insurance or retail pharmacy costs, if you qualify.

Q: I am a 75-year-old man who has recently found myself unable to hold back urinating much of the time. I cannot get to the bathroom soon enough or can’t unzip my pants fast enough. I know there are supposed to be exercises for this, and I have tried them from time to time with mixed results. I think I am too far gone 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 was on a Flomax derivative for quite a while to control the size of my prostate, but was taken off of it by my cardiologist due to shortness of breath, which is now gone. Every once in a while, I take one anyway, but I don’t think this would be any help toward solving the problem. Is there anything I can do?

A: Urinary urgency (the sense of needing to go right away) is common in older men, usually due to the prostate but sometimes due to an overactive bladder. Infection needs to be ruled out first, then a drug like tamsulosin (Flomax) is often tried. If this isn’t 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 route of medications, I will refer my patients to a urologist, who has the ability to test whether it’s the prostate or the bladder that’s the real problem.

Pelvic floor exercises are effective for both men and women with overactive bladder symptoms, but you need to find out what’s causing the problem (infection, prostate or bladder) first.

Q: I have always wondered if it matters if you swallow a bunch of pills in one swallow or if it would be better to space them out. I take a bunch, like Eliquis, dicyclomine, gabapentin, etc.

A: With most pills, it’s OK to take them as a bunch together, if you can tolerate doing so (I’ve known people who have a tough time taking multiple pills at the same time due to gagging). There are a few combinations of pills that shouldn’t be taken together, such as tetracyclines and calcium, but these should be labelled clearly on your bottle. A few medicines, like alendronate (Fosamax), can’t be taken with any other medicines. Some medicines, including all the ones you mentioned, can cause sedation, which can be worse if taken together.

As always, your pharmacist is your best friend for questions about medication interactions.

Q: Despite having family history of high cholesterol (including early death due to heart failure), I was told at 53 that my 10-year risk is not alarming. I do not smoke nor drink.

I recently had some tests done and was told that my Lipoprotein (a) is above normal. I am wondering if that may explain my concern of why, despite keeping a very careful diet over two decades (and a fairly good Mediterranean diet before, as well) and an ideal BMI, my figures are not getting better. (I still have a high LDL, low HDL and high triglycerides.)

After I recovered from COVID, I seemed to have a high pulse and was advised that my stress ECG is positive. I find aerobic exercise very challenging but keep active when I can. I tend to be anemic and feel tired very often due to heavy periods, but I take iron supplements.

What should I do concerning my cholesterol in my blood? I am concerned that my high figures may indicate a silent serious illness.

A: The 10-year risk is a good place to start in deciding whether elevated cholesterol needs to be treated; however, the 10-year risk does not consider some risk factors, including the high Lp(a), which is an independent risk factor on top of your high LDL and low HDL. The Lp(a) doesn’t affect the other cholesterol numbers.

Diet and exercise do tend to help cholesterol numbers and definitely help reduce heart disease risk, but it is possible to have cholesterol results that are not ideal despite a very good lifestyle.

A positive stress test is a concerning finding and is usually followed up by a definitive test for blockages in the artery, such as an angiogram. The results of that will absolutely guide your cardiologist as far as further treatment, including whether you need treatment for your cholesterol numbers.

Although statin drugs do not reduce Lp(a), they do reduce the risk of heart disease in people with elevated levels of Lp(a). I follow the advice of experts who recommend a lower threshold for medication treatment in people with high Lp(a) levels, especially in people with a family history of heart blockages or heart attacks.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.

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