$4 prescription plans

Disclaimer: I am in no way affiliated with the companies mentioned below, nor do I receive any kind of reimbursement for endorsing any of their programs.

Ok- so now that's out of the way, I'd like to discuss the $4 Rx plans put in place by Target and Wal-Mart. Although I am definitely not a big fan of the corporate world "big fish eating the little fish", when it comes to medications for our patient population, this is a great plan!

Basically, the premise of this program is that both companies offer certain medications that are available in the generic form as a $4 a month Rx, regardless of insurance plan (or for that matter uninsured), or income levels. I cannot express the number of times I have walked into our clinics, ER, inpatient rooms, etc and taken a patient's history only to realize that many of the times, the reason they are in the hospital is because of medication non-compliance. Although I've never actually performed any statistical data on it, I believe the most common reason I get from my patients for not taking their meds is "doc- I just couldn't afford it". That being said, I do note that many of our patients continue to smoke, drink, chew tobacco, etc. all of which are pretty expensive habits anyway- further decreasing their funds for purchasing medications. Well- now we have a plan that allows our patients to purchase their monthly supply for only $4! We have had other Rx plans available to our patients, long before these plans were available, that allowed them to receive certain medications in a 3 month supply for only $20. Well, with this plan, a 3 month supply still SAVES them $8! Not only do I recommend my patients who do not have insurance to start filling their meds that are available for $4 at either of these two stores (I don't prefer one over the other- as long as they take advantage of the savings), but I also have started to recommend it to my patients who do have insurance, my parents, family friends, etc. Many insurance plans offer copays of $15, $20, or $25 and up for 1 month supplies, when some of these medications are available for $4 regardless of insurance type.

Of course, the downside is some of these medications are older medicines, and new meds in the same class are now in the market with studies backing them up that show better efficacy- but how does better efficacy help a patient who can't afford the medicine in the first place? I'd prefer to put them on the older medicine that they will be able to afford, and improve compliance, and have a SLIGHTLY diminshed efficacy- overall, it still benefits the patient more than not taking any medicine.

So what did I do last month while I did an inpatient rotation?? I carried a list of those medications in my coat pocket (short coat of course), and discussed with my patients about changing some of the medications that they were having problems affording to comparable ones that they would be willing to pay only $4 for. Turns out, I changed some medications for quite a few of my patients on the wards, with the hopes that with the decreased cost, they'd have better compliance rates, and hopefully keep them out of the hospital for longer periods of time. Interestingly, this can be something that can easily be studied- determine compliance in a survey prior to the changes in medicines, measure objective parameters of overall health, determine reasons for admission to the hospital, then on follow up after discharge, see how the objective parameters improve and do a repeat survey to see if compliance has improved. Also, you can determine if the time between admissions increases most likely due to improved compliance especially for our "chronic admissions" that we all see at most hospitals.

In short, I would like to say Kudos to both Target and Wal-Mart for such a great plan. I hope that this may help our patients (from all income levels) improve their compliance due to overall decreased costs. That being said, MDs have to also do their part in reviewing a patient's medications, and determining if changing the medications to a less expensive alternative is a feasible option.

I suppose after I move to Boston, I will see whether or not the patients over there (where I assume many DO have insurance) have similar comliance issues because of cost. Does anyone else have any opinions on these plans? Do any of you take advantage of the $4 plans?