Do not want Superdrugs, just regular ones.

February 11, 2008 11:47 AM

How do I talk to my doctor about the prescription she gave me without pissing her off?

The last time I was at a doctor was when I was in college and I went to the college's health center. As a graduate I can no longer go back there. Recently I got a physical and asked my new doctor for a prescription for a chronic condition because OTC treatments weren't quite enough (Aveeno Hydrocortisone). When I went in to get the prescription filled the pharmacist said it was $92 for the generic version with my prescription card! I work part-time and this is way out of my price range.

When I got home I looked on the internet and discovered that the prescription is a very powerful drug "super-high potency corticosteroid". When I checked on a (very) reputable website it classed the prescription as class 7 (the highest) and the OTC Aveeno as the lowest.

I don't understand why my doctor would prescribe me the superdrug when I had told her that the OTC was kinda working. Why not go for something in the middle?

I thought about telling her that it was just too expensive (which it is) but am afraid that she might prescribe something just as strong but not so expensive. I don't want her to feel like I am second guessing her because of the internet, which as I understand it, is a pet-peeve for doctors. Any suggestions on how to bring this up without pissing her off? I actually like her as a doctor and don't want a negative doctor/patient relationship.

ps Also, am I going to have to get a new appointment for a different prescription? Or is this something I can do over the phone and pick it up later? I have very shitty insurance and they may or may not cover another appointment.

posted by silkygreenbelly to health (18 comments total)

This sounds like it ought not be such a big deal. Call her and tell her you wonder if it might be overkill, and it's also a financial burden. Just that: This prescription seems like it's for something really strong, could I start off lighter? Would that make it cheaper for me? That's exacly something doctors need to hear to give ou personalized service. If she makes your input seem unwelcome, she's a crappy doctor. I loved my university doctor, and too recommendations from him on who to see after graduation. Perhaps you could call your old uni doctor for a recommendation, too!
posted by Ambrosia Voyeur at 11:56 AM on February 11

Funny, I had exactly the same experience with the same drug. Some brands are just more expensive than others, and various brands are covered differently by different insurance plans. The doctor knows this but is busy treating patients and does not have price information at her fingertips.

Also, there isn't necessarily a relationship between potency and cost.

Research which ones are cheaper on your insurance plan (online or with the pharmacist) and phone the doctor with a list, and let her choose which one to prescribe. Then she'll mail you a new prescription. This is routine. Pissing off is not an issue.
posted by JimN2TAW at 11:56 AM on February 11

There's no reason for the doctor to get pissed off. Just call the office and explain that the drug sounds like something that is stronger than you want to take as well as being too expensive. She should be more than happy to accommodate you unless there's some very important reason why she believes you should take this particular drug.

Also, am I going to have to get a new appointment for a different prescription?

No. She just saw you; she can change the prescription over the phone.

Any doctor who gives you a hard time about this is unreasonable and not someone you want to see. Your issues with your prescription are very common. Patients need to change drugs all the time and it's something physicians are used to dealing with.
posted by Violet Hour at 11:58 AM on February 11

I actually like her as a doctor and don't want a negative doctor/patient relationship.

If this causes any problems in the doctor-patient relationship, you should stop liking her as a doctor.

Answering these questions is a routine part of her job.
posted by winston at 12:00 PM on February 11

I think the best course of action would be to call the doctor's office and explain that you cannot afford $92 for a prescription, and ask them if the doctor can write a prescription for something cheaper. It's kind of difficult for them to argue that point.

Regarding whether the prescription is too strong, my tendency is to side with the doctor on that one (though I'm not a doctor, I'm just a guy on the internet)... maybe it's easier/faster/cheaper/more reliable to overprescribe and get the problem fixed with the first prescription than it is to ramp up the strength in incremental steps.

You, however, have every right to determine what will and won't be used on your body, and if a simple question about the strength of a medication offends the doctor so deeply, maybe they should have gone into another profession.
posted by MegoSteve at 12:00 PM on February 11

I know once when I was prescribed a superdrug thing (same sort of thing, only safe to use on eyelids. Apparently cortizone can make you go blind?) the pharmacy was happy to call the Dr. and see if there was an option. When there wasn't, the Dr. called my insurance and explained that the cost was way too high for me if I had only 10% coverage, but it was the only option to heal my problem. In the end, my insurance covered it and I paid a $20 co-pay. I think the original cost was like $110.
posted by foxydot at 12:03 PM on February 11

In similar circumstances I've been able to call the doctor's office, rather than going in for another appointment. Usually I'll leave a message for the doctor, and then the doctor's nurse will call me back to ask details, and then later the nurse will call again to say that the doctor approved the medication switch. It's helpful to have the phone number for your preferred pharmacy handy, because you can give it to the nurse and they'll phone the prescription in for you. It's a bit of phone tag, but still probably more convenient than going to the office in person.

I have no advice on the "how not to annoy the doc" front. I often wonder about this myself, since I try to stay very educated about any conditions or medications I'm dealing with. I don't want to come off like my internet research has made me an expert, since they're the ones who went to med school. Still, sometimes I wonder if my couple hours of diligent research doesn't make me more of an expert on this one particular subject than my GP who has a zillion other things to deal with and remember. I've found that young doctors seem less likely to take offense to a well-informed patient, but that won't help you much since you've already got the doc picked out.
posted by vytae at 12:05 PM on February 11

No worries, the doctor really shouldn't have a problem with switching the script. Be up front, tell her that you'd like to try a lower potency first to see if it works, and then move up to the big guns if needed.

It probably is just a standard script for your condition, and rather than have someone try a less potent script and have to come back for additional visits, she just goes with what will work in most cases (as long as there aren't adverse side effects).

Doctors deal with second guessing all the time, and as long as you don't pretend to know more than you do, things should be fine.
posted by shinynewnick at 12:06 PM on February 11

There's nothing wrong with being aware of what works for you and talking to the doctor about it. There WOULD be something wrong with your not being willing to hear her explanation of why she thinks you should take a different drug instead. You're paying for her expertise so not listening to it is foolish.

Just stop thinking of the fact that because someone is an authority on a subject - whether it be medicine or auto repair - makes them an authority over you. You're a paying customer and they work for you, even if your insurance pays the majority of their fee. After all, you work in some capacity to pay those insurance premiums.

For future visits, confront this prescription cost issue up front. "Is this a generic? My insurance doesn't pay well, so if there's a generic alternative that would be best." I'd be shocked if there's a doctor in the US that hasn't been asked this before, if not this week, and one who isn't sympathetic to the high cost of health care is one you're better off without anyway.

You might also get yourself a Costco membership. During the long dark period where I was paying out of pocket for insurance with a high deductible I discovered that they were cheaper than every other alternative I had near me. Cheaper than my insurance company's mail-order pharmacy, even. In the years since then Wal-Mart and Target have gotten more aggressive about low cost drugs
posted by phearlez at 12:18 PM on February 11

Whoops, premature submit.

In the years since then Wal-Mart and Target have gotten more aggressive about low cost drugs, so it's possible for many generic they're as good or cheaper; it's not as big a concern for me these days. But there's a TREMENDOUS disparity between prescription drug prices, in no small part because most insured consumers have no personal cost motive to find the lower price supplier.

This NYPIRG article lists some disparities. Look at the paragraph titled " Regionally within New York State" to get an idea how different prices can be even on popular medicines.
posted by phearlez at 12:25 PM on February 11

To understand why she might have given you the most potent drug in the anti-inflammatory arsenal, imagine that she prescribed one in the middle range and it wasn't quite strong enough, and you came back again for the same problem. The insurance company might ding her for that because it cost them another visit.
posted by jamjam at 12:39 PM on February 11

Don't overlook the intervention of your pharmacist. They can actually be quite helpful, and will recommend alternative drugs (with an understanding not only of the drugs characteristics, risks and benefits, but also of the cost and your insurance coverage). And in some cases, they can call the doctor on your behalf and ask whether the doctor will approve an alternative treatment.
posted by MrsBell at 12:54 PM on February 11

I have no advice on the "how not to annoy the doc" front. I often wonder about this myself, since I try to stay very educated about any conditions or medications I'm dealing with. I don't want to come off like my internet research has made me an expert, since they're the ones who went to med school. Still, sometimes I wonder if my couple hours of diligent research doesn't make me more of an expert on this one particular subject than my GP who has a zillion other things to deal with and remember. I've found that young doctors seem less likely to take offense to a well-informed patient, but that won't help you much since you've already got the doc picked out.

For anyone who has concerns or hesitation along this line, you might check out a book called You: The Smart Patient: An Insider's Handbook for Getting the Best Treatment. It was written by doctors, alongside the the Joint Commission, the nation's premier health care evaluation org. I found it a really helpful tool for understanding where the lines fall in the doctor-patient relationship.

There is a distinct difference between a hypochondriacal self-diagnosing pest who Knows It All thanks to Dr. Google... and an informed patient who is proactively participating in his own care.
posted by pineapple at 1:19 PM on February 11

The person in charge of your medical care is you. The person best placed to advocate for your medical needs is you. Most people are raised to view doctors as powerful authority figures, but the ultimate authority on care decisions is yours.

By all means, ask for what you think will work best for you. You should, because it's your money and your health. Obviously, if your doctor has some compelling reason for the prescription she made, then you'll want to asses that information and make a decision from there, but if you don't question this in the first place, you'll never find out why an important decision was made about your needs.

So ask. Be polite and be cheerful about it, because this should not be an adversarial relationship, but do ask.
posted by DarlingBri at 1:52 PM on February 11

I don't want her to feel like I am second guessing her because of the internet, which as I understand it, is a pet-peeve for doctors. Any suggestions on how to bring this up without pissing her off? I actually like her as a doctor and don't want a negative doctor/patient relationship.

First of all, "pet peeve" does not equal "pissed off," nor does it equal "will turn positive relationship into a negative one." It's good to respect doctors, but you don't need to walk on eggshells to this extent.

Second of all, you're not insisting that a common aliment is an obscure disease because the internet said so, you're asking a completely legitimate question about health care that you're received.

Tell her that you can't afford the prescription, and also tell her that you were surprised that she went straight to such a potent version and that you wonder why.
posted by desuetude at 1:57 PM on February 11

Don't worry about it. Seriously. This sort of thing happens all the time and doctors certainly don't get pissed off about it, especially when it's not an exceedingly regular occurrence with the same patient. I know because I'm on the other end of insurance issues, potentially costly drugs, and patient concerns all of the time.

What was said above is true: the cost and potency may not be very closely correlated, so don't worry so much about potency. Just ask if there's a cheaper alternative because you can't afford that copay and I'm sure your doctor will think of something. Even if a comparable potency agent isn't available, I suspect a trial of a mid-strength alternative would be preferred by most doctors over sending you to the poor house.

If your concern is the potency itself as opposed to the cost, and you're worried about side effects, just say you're nervous about an adverse reaction and ask why they chose the strong stuff. Usually, the choice of potency of these types of topicals depends on where it's being applied (the thickness of the skin at that location) and what has previously failed. But a lot of these types of decisions are more art/experience than science.
posted by drpynchon at 3:35 PM on February 11

There's a good consumer-empowerment part to this question as well. Physicians need to be trained to ask "how is your prescription drug coverage, because this medication that I am prescribing can be expensive"

I recently had to take an antibiotic that cost me $150 out of pocket, because I have no prescription coverage. I called my doctor and complained that she had not adequately informed me of what was going on. It turned out she could have prescribed a different much cheaper drug, but it never occurred to her that I might have a problem with the price. So definitely, educate your doctor!
posted by nax at 5:08 PM on February 11

You may want to ask your doctor if she has any samples of this medication. Mine does that all of the time.
posted by JujuB at 6:43 PM on February 11