Prior authorization (PA) is a tool to control usage, improve therapy outcome, and manage costs.  It is a process that promotes appropriate medication use by approving non-formulary drugs that meet specific, defined criteria.  As a result, PA controls the use of high-cost medications by assuring that lower cost and what’s considered therapeutically equivalent agents are used first.  The FDA defines therapeutic equivalent as “drug products that can be substituted with the full expectation that the substituted product will produce the same clinical effect and safety profile as the prescribed product.”  One example is the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Naprosyn) as first-line agents before approving and paying for more expensive COX II inhibitors such as celecoxib (Celebrex).

The PA process can be handled by phone or fax.  Oftentimes, all it takes is a phone call from the doctor’s office to provide the insurance company with information that includes medical diagnosis, previous medication history, and other chart information.  If the PA is approved, you’ll get the prescribed drug.  If the PA is denied, the doctor will prescribe a new formulary drug that is approved for coverage by the insurance or he may insist that you pay out of pocket for the non-approved drug.

As a patient, you may have to wait anywhere from 1 to 3 days to get a medication.  So what do you while you wait for the medication to be approved?  There are several options.  First, you can purchase a few pills until the medication is approved.  Second, some plans may approve a 3-day supply while your doctor works on the PA.  Finally, you may ask for recommendation of other alternatives or over the counter medications that may be used for a few days.  As always, check with your doctor or pharmacist.

Disclaimer: All contents published on RxInfoBlog.com is provided for informational and educational purposes only. Like any printed material, it may become out-of-date over time.  The site and its services are not a substitute for professional medical advice and treatment. Always seek the advice of your doctor before making any changes to your diet, health routine or treatment.

These recommendations were published in 2004 by the National Academy of Sciences. For a complete list of all recommendations from this report, see the following at Dietary Reference Intake .

Disclaimer: All contents published on RxInfoBlog.com is provided for informational and educational purposes only. Like any printed material, it may become out-of-date over time.  The site and its services are not a substitute for professional medical advice and treatment. Always seek the advice of your doctor before making any changes to your diet, health routine or treatment. 

Hippa stands for Health Insurance Portability and Accountability Act.  It was enacted by Congress in 1996.  It establishes regulations for the use and disclosure of an individual’s Protected Health Information (PHI).  In health offices and pharmacies, new patients are given information regarding how their PHI is used.  Basically, information may be disclosed to another healthcare professional whose care you’re under.  However, it cannot be disclosed to another family member if the patient is over 18 years of age.  For example, while a spouse may pick up a medication for the wife or husband, he or she cannot pick up the other’s medication records.  There is a good reason for this.  There have been instances when the husband or wife has obtained the spouse’s medication records without his/her knowing it to use it in a divorce or custody battle.  Therefore, the only way it would be allow is that a consent form is filled out by the patient stating that a designated person may pick up his records.  Check with your pharmacies on the specific details.  Anyone who believes their privacy is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR).

Disclaimer: All contents published on RxInfoBlog.com is provided for informational and educational purposes only. Like any printed material, it may become out-of-date over time.  The site and its services are not a substitute for professional medical advice and treatment. Always seek the advice of your doctor before making any changes to your diet, health routine or treatment.

Medicare prescription drug coverage, also known as Medicare Part D is insurance that covers both brand-name and generic prescription drugs at participating pharmacies, thus providing protection for people who have very high drug costs or from unexpected prescription drug bills in the future. 

Under this plan, an individual will pay a monthly premium, a yearly deductible, and a copayment for the prescription.  These costs vary depending on which drug plan is chosen.   There are numerous Medicare Part D plans available that differ by the drugs covered which determine the costs of the plan.  Not surprisingly, plans that offer more coverage and more drugs will cost more.  However, it is best to select the plan that covers most of your current medications and not ALL medications.  Several pharmacies offer free reports that will help you sort out the best plans for your medication needs.

For individuals with limited income and resources, and they may qualify for extra help and may have to pay a premium or deductible. You get more information about the extra help by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or by visiting their website at www.socialsecurity.gov.

Everyone with Medicare is eligible Medicare Part D prescription coverage, regardless of income or current health status.  Individuals may sign up when they first become eligible for Medicare (three months before the month turning age 65 until three months after turning age 65).  Failure to sign up at the appropriate time may result in a premium penalty for late enrollment.

Some important dates to remember are:

• January 1 - coverage begins for individuals who have enrolled
• May 15 - enrollment closes for the current calendar year
• November 15 to December 31 - enrollment opens for the next calendar year

For more information about the Medicare Part D plan, visit www.medicare.gov.

Disclaimer: All contents published on RxInfoBlog.com is provided for informational and educational purposes only. Like any printed material, it may become out-of-date over time.  The site and its services are not a substitute for professional medical advice and treatment. Always seek the advice of your doctor before making any changes to your diet, health routine or treatment.

When do you use cold compresses versus hot compresses after an injury?  Some orthopedic surgeons have provided the following recommendations.  Following an injury, they recommend using a cold compress.  This process cools the injury and promotes constriction of the vessels which in turn reduces inflammation and swelling of the area.  Once the swelling has been reduced, hot compresses is recommended to promote healing by increasing blood flow to bring nutrients to the injured area and prevent infection.  Examples of warm compresses include a warm towel or a heating pad.  For cold compresses, use a cold towel or and ice pack.

Disclaimer: All contents published on RxInfoBlog.com is provided for informational and educational purposes only. Like any printed material, it may become out-of-date over time.  The site and its services are not a substitute for professional medical advice and treatment. Always seek the advice of your doctor before making any changes to your diet, health routine or treatment.   

Blood pressure is a measurement of the force applied to the walls of the arteries as the heart pumps blood through the body. The top number is called the systolic blood pressure (SBP), and it represents the maximum force exerted when the heart contracts. The bottom number is called the diastolic blood pressure (DBP) reading, and it represents the pressure in the arteries when the heart is at rest.

High blood pressure is a risk factor for heart disease.  By controlling blood pressure, you can reduce your risk of heart attacks, stroke, and even death.  Depending on the number of risk factors including family history of heart disease, blood pressure goals will be different from one person to the next so make sure to check with your doctor.  Check out the table below as a reference for blood pressure classification.

Disclaimer: All contents published on RxInfoBlog.com is provided for informational and educational purposes only. Like any printed material, it may become out-of-date over time.  The site and its services are not a substitute for professional medical advice and treatment. Always seek the advice of your doctor before making any changes to your diet, health routine or treatment. 

Drug companies spend billions to bring a new brand name drug to the market.  Once the drug is approved, the company is given the right to exclusively manufacture and market the drug until the patent expires.  These new drugs are usually expensive because the company must try to recover the costs as well as make profits to finance further research and development.

Once the patent of brand name drugs expires, other companies apply to the FDA to start manufacturing generics versions of the brand drug.  The reason companies can sell generics for cheaper is because they don’t have to spend the money for research and development of a new drug.  Generics are basically a copy of the brand name in terms of the active ingredient(s).  They may look different from the brand name drugs in shapes and colors due to inactive ingredient(s).  The FDA also requires that the generic drugs be as effective and as safe as the brand drugs.  The FDA estimates that about 50% of the generics are made by the same company that makes the brand name drugs.

The FDA does allow for slight variations due to manufacturing which is about a 3 percent difference in the amount of drug absorbed, and about a 4 percent difference in the peak plasma concentration.  This variation is not clinically significant in the majority of medications.  However, for certain medications that treat thyroid, seizures, or blood thinners where therapeutic levels are often maintained at a narrow margin, switching between brands and generics may affect the drug levels in the body.  In these cases, once a medication (either brand or generic) is started, patients should check with their doctors or pharmacists before switching.  If you have questions regarding whether your drug is affected by changes in levels, consult with your doctor or pharmacist. 

Disclaimer: All contents published on RxInfoBlog.com is provided for informational and educational purposes only. Like any printed material, it may become out-of-date over time.  The site and its services are not a substitute for professional medical advice and treatment. Always seek the advice of your doctor before making any changes to your diet, health routine or treatment.

Previously, patients were told to flush medications down the toilet to dispose of them.  Unfortunately, that advice has proven to be not so great anymore.  In March, a study conducted by the Associated Press found that small traces of drugs were found in several major cities’ drinking water.  That is why we should not continue to flush unused medications down the toilet.  Instead, the current recommendation is to first crush the medications, then mix them with cat litter, and finally place the contents in a sealed plastic bag to be disposed of with your trash.  Alternatives to cat litter include coffee grounds and sawdust as suggested by the Substance Abuse and Mental Health Services Administration. 

Disclaimer: All contents published on RxInfoBlog.com is provided for informational and educational purposes only. Like any printed material, it may become out-of-date over time.  The site and its services are not a substitute for professional medical advice and treatment. Always seek the advice of your doctor before making any changes to your diet, health routine or treatment. 

Grapefruits and certain medications should not always be taken together.  Grapefruit contains a chemical called furanocoumarins (FCs) that can affect the concentration of some medications. Researchers have found that FC alters the activity of the enzyme in the intestinal tract that metabolizes the drug.  This effect results in either higher or lower drug levels in the blood stream.  For example, it can increase the concentration of certain blood pressure and cholesterol medications while decreasing the concentration of some antivirals and antifungal medications.   Before consuming grapefruits or grapefruit juice while on prescription medications, always check first with your health care professionals. 

Disclaimer: All contents published on RxInfoBlog.com is provided for informational and educational purposes only. Like any printed material, it may become out-of-date over time.  The site and its services are not a substitute for professional medical advice and treatment. Always seek the advice of your doctor before making any changes to your diet, health routine, or treatment. 

There has been some confusion on how much prescription coverage is available to certain individuals who have Medicaid.  In the State of Texas, for example, a person is limited to three prescriptions per month unless they are classified as a nursing home patient or are children then they have unlimited prescriptions per month.  Maximum fills on Medicaid prescriptions are for six months; this means that even if you doctor gives you a prescription with refills for a whole year, Medicaid in Texas will require a new prescription after six months.  However, if you want to pay out of pocket for the prescription, then you can purchase the medication until the prescription expires after 1 year for non-controlled drugs, and 6 months for controlled medications.  Check with your pharmacies, every state is a little different.  Most pharmacies will automatically contact the prescribers for you to obtain a new prescription.  Just remember to call in advance to give them time to contact you doctor.  As mentioned previously, you can always choose to pay for the prescription if you cannot wait.  You may also ask your pharmacists to loan a few pills until the doctor gets back with them.

Disclaimer: All contents published on RxInfoBlog.com is provided for informational and educational purposes only. Like any printed material, it may become out-of-date over time.  The site and its services are not a substitute for professional medical advice and treatment. Always seek the advice of your doctor before making any changes to your diet, health routine or treatment.