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Just What The Doctor Ordered?

By Dr. Larry Tune

(Page 1 of 2)

During these tough economic times everyone is looking for ways to save money and cut costs.  In my practice, more and more I see insurance companies and pharmacies attempting to reduce health care expenditures.  This is a noble cause – unless it negatively impacts patient health.  Using words like “generic alternative” and “therapeutic equivalent”, medications are being switched – and this could have unintended consequences our health care system. 

Switching often occurs when someone other than your doctor suggests a medicine that is chemically different than the medicine your doctor prescribes.  My concern is that patients may be led to believe that the medicines are truly the same, and then they end up with less than spectacular results, or unwanted side effects.

Medicine switching is not always bad, if the decision is made by the doctor and the patient.  But sometimes this occurs without either one’s knowledge and is driven by the financial gain of the third party.  As we all know, individuals respond differently to different medicines. and there is no such thing as “one size fits all.”  Doctors wouldn’t be needed if it was that simple.

Finding the correct antidepressant or anti-dementia drug for a patient sometimes involves a long, difficult trial and error period, which can be complicated by side effects or drug interactions.  This is sometimes forgotten, and after a “recommended” medication change, patients end up back at “square one” trying to find an appropriate medicine.

A survey conducted by the National Consumer League (NCL) found that two-thirds of people who reported medicines switched for themselves or a family member said that they were not consulted about the switch.  Nearly half were dissatisfied (or their family was) with how the process occurred and report that the substitution did not end up resulting in lower costs.

Sally Greenberg, NCL Executive Director, was quoted in a press release stating: “Consumers are justifiably concerned about the practice of therapeutic substitution, how it’s done and who’s involved. Without transparency, therapeutic switching could introduce efficacy or safety issues, including unknown drug interactions and potentially serious health consequences.  It may evoke confusion or fear on the party of patients already feeling frustrated by a failing health system.”

The NCL identified the four most common medicine switches are antidepressants, cardiovascular medications, epileptic medicines and proton pump inhibitors. I encourage my patients to be aware of this practice and urge them to take an active role in managing their health care. It’s important for patients to ensure that their health and treatment – not financial motives – are the top priority.


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