Using Your Medications Safely

Did you know each year thousands of people end up in the hospital, fail to get better or spend too much money all because of problems with their medicines? Well, it’s true. Each year we spend about a billion dollars on medication-related problems. This can include events due to adverse effects from medicines or drug interactions. Also, not using your medications appropriately can result in “therapeutic failure” or receiving little or no benefit from a medication. Skipping doses or stopping a medication because you “feel better” may do more harm than good. Your health problems could continue or worsen and you may end up needing a more expensive treatment than before. While it is your doctor’s job to prescribe medications, it’s your job to manage their use. Here are some tips on ways you can do this safely and effectively.

Communicating with the Doctor

• Describe or show your doctor all the medicines that you take (or you can also show your prescriber a list of your medicines). Be sure to include any medicines that you buy over-the-counter or without a prescription.
• Let the doctor know about any allergy or problem that you have had with medicines in the past.
• Ask your doctor to explain your prescription before you get it filled, including the drug name - if applicable, both brand and generic - and how often you should take it.
• Tell your doctor to write the purpose of each medicine on the prescription. This can help you and your pharmacist double-check the prescription.

Communicating with the Pharmacist

• Before leaving the pharmacy, make sure your pharmacist goes over each medication with you. Update your medication list if any prescriptions change or if new medications are added.
• If you are getting a refill, make sure that the medication looks familiar; if it does not, ask the pharmacist about it before taking it.
• If the drug is too difficult to swallow, ask if a liquid is available.
• If needed, tell the pharmacist that you need “easy off” tops/caps for your bottles.
• Ask your pharmacist about proper storage of medications. It’s usually best that you don’t store them in the bathroom medicine cabinet or in direct sunlight. Humidity, heat, and light can affect medications’ strength and safety.

Beware of Medication Side Effects

• The individual who knows the most about your health is you. If you begin a new medicine or increase the dose of an old medicine and notice something “changes” in you, please let your doctor or pharmacist know immediately.
• Medication side effects can be mild or very serious … even fatal.
• More common side effects include drowsiness, confusion, constipation, dry mouth, and stomach upset.
• If you feel that a drug is doing more harm than good, discuss the matter with your doctor; he or she may be able to substitute another medicine that will work better for you.

Reducing Your Medication Costs

One of the major concerns facing many older adults today is the rapid rise in medication costs. Although seniors represent only 12% of the U.S. population, they account for about a third of drug expenditures. Despite the advent of Medicare’s prescription drug benefit, many seniors are still struggling to afford their needed medications; some are finding it difficult to meet the out-of-pocket expenses required by Medicare Part D.

When medications are used safely and effectively, they are probably some of the most cost-effective preventive care tools we have in healthcare. While little can be done to change drug pricing, there are ways to decrease costs. Here are some tips:

Talk to your Doctor or Pharmacist

• Have your doctor or pharmacist review your medications regularly to make sure you’re not taking drugs you don’t need anymore. Keep an up-to-date list of all the medicines you take, including prescription, over-the-counter, and herbal products. This might prevent harmful drug interactions or taking duplicate medicines.
• If you feel that your medication is too expensive, ask if a less expensive one can be used.
• Generic versions of many brand-name drugs are available. A generic version is the same medicine, but with a different name, and usually, a lower price.
• For drugs taken on an ongoing basis that are not likely to change, you can save money by buying prescriptions in larger quantities. Ask your doctor to write for several months supply.
• Ask about drug samples (especially if this is a new drug to you), non-drug alternatives, or over-the-counter options that can control symptoms.

Choose a Pharmacy that is Right for you

• Even if you have a Medicare prescription drug plan, ask the pharmacy if they offer additional discounts for seniors.
• Medication prices vary at different stores, and it may pay to compare prices. “Discount” drugs are not always the cheapest ones, since the price may have been inflated before it was “discounted.” However, it may be worth paying a little more if you find a pharmacist you trust who looks out for your best interests.
• Mail order or on-line internet pharmacies are most appropriate if you are taking a medication on an ongoing basis. While you may save direct drug costs, you will not receive the face-to-face counseling with a pharmacist, which can be critical.

Learn about Available Benefits

• Medicare now offers an optional prescription drug benefit that seniors and people with disabilities can purchase to help them reduce the cost of needed medicines. Beneficiaries with extremely limited income and assets may also qualify for extra subsidy assistance to help them better afford these plans.
• Medicare Part B covers much of the cost of a few oral cancer medicines, drugs that suppress the immune system, medications that go into nebulizers (breathing machines), and the strips used to check blood sugar levels.
• Some insurance companies, HMOs, and other public programs may pay for some or all of the cost of your medicine. Check the fine print to see if you have a medication benefit and how much your co-pay will purchase.
• Many drug manufacturers have “patient assistance programs” to help get medicines to people who cannot afford them. Each company has different guidelines and the process will likely involve paperwork. Ask your doctor’s office to assist you and you can find more information on our Links page, under Prescription Assistance Programs.

Understanding Medicaid and MQB

At Senior PHARMAssist, we meet many Durham seniors who might qualify for one of North Carolina’s medical assistance programs, also called Medicare Savings Plans. One of the best referrals we make is to Medicaid programs. We want to tell you what is available and how to apply. If you receive Medicare and meet specific requirements, you may be eligible for one of two programs: Medicare Qualified Beneficiary (MQB) or Medicaid.

Note: If you’re already enrolled in one of these programs, you automatically qualify for extra subsidy assistance from the government to help you purchase Medicare prescription drug coverage. As a “dual eligible,” you will be auto-enrolled in a Medicare drug plan if you do not select one, but you may change plans - up to once a month - after the open enrollment period ends. This does not apply to other Medicare beneficiaries.

Medicare Qualified Beneficiary (MQB)

If your income is less than $1,190 (single) or $1,595 (couple), then you might be eligible for MQB-B or MQB-E. Both of these programs pay your premium for Medicare Part B. This premium of $96.40 is usually taken out of your monthly social security check. If you receive MQB-B or MQB-E, then you will get to keep this money ($1,157 in a year)!

If your income is less than $887 (single) or $1,187 (couple), then you might qualify for MQB-Q. This program pays your Medicare Part B premium and also pays your Part B deductibles and copayments. None of the MQB options pays for prescriptions.

Medicaid

If your monthly income is less than $887 (single) or $1,187 (couple), and you have cash assets of under $2,000 (single) or $3,000 (couple) you may apply for Medicaid. Some Medicaid benefits include:

• Eye care with eye doctors who accept Medicaid
• Dental care with dentists who accept Medicaid
• Payment for hospital deductibles and visits
• Payments for visits to your doctor
• NOTE: Prescription benefits for those who are Medicaid eligible are now administered via the Medicare program, though Medicaid may pay for some medications not covered by a beneficiary’s Medicare drug plan.

Debunking a Medicaid Myth:

• You CAN own your home - as long as you live in it - and a vehicle, and still qualify for Medicaid.

To apply for Medicaid or MQB in Durham, go in person to the Medicaid office at 300 N. Duke Street on Monday - Friday, from 8:15 a.m. to 4:30 p.m. When you go, take your Social Security card, your Medicare card, your most recent bank statement, the name and number of any life or health insurance policies you have, and any outstanding medical bills. If you have any questions, contact the Medicaid office at 560-8800.

Medical and Nursing Home Advocacy

Senior PHARMAssist is designed to help improve the lives of older adults in Durham by providing health education and financial assistance for medications. We see participants every six months to discuss their medicines, review preventive health measures, and provide community referral information. In talking with our participants, we sometimes hear about things that are going on that shouldn’t be. The Medical Review of North Carolina and the Ombudsman’s Program are two programs available in the Triangle that advocate for seniors who may not be getting the help they need. While decreased Medicare funding to hospitals and nursing homes is a concern, the level of care that beneficiaries receive should not be compromised.

The Carolinas Center for Medical Excellence

The Carolinas Center for Medical Excellence has a contract with the federal government to ensure that Medicare patients receive quality medical care. Your rights as a Medicare beneficiary include receiving: all the hospital care that is needed for your illness or injury; information about what Medicare covers during your hospital stay and after discharge; and a review by the CCME if you are concerned about the quality or amount of care you received while in the hospital. Examples include if you are uncertain why you have been denied admission to the hospital, or if you believe you are being discharged from the hospital before you are medically ready. If you have any questions about medical care you receive as a Medicare beneficiary, or believe the care was not as good as it should have been, call the Carolinas Center for Medical Excellence at 1-800-682-2650.

The Ombudsman’s Program

The Ombudsman’s Program in Durham is part of the Triangle J Area Agency on Aging. Ombudsmen provide referral information, technical assistance, advocacy, and conflict resolution to long-term care residents and their families. They can give you information on the rights and services nursing homes and adult care homes are required to provide residents. They can also tell you how to become a legal guardian for a cognitively impaired relative, or how to report abuse and neglect in long-term care facilities. Ombudsmen can play a significant role in advocating for individual residents, through direct observation within a facility, assistance with problem solving, and mediation. Complaints or concerns discussed with an ombudsman are confidential. The vast majority of complaints received are resolved informally through an ombudsman’s involvement.

You can learn more by clicking here or calling, if you have any questions or concerns about the care you or a loved one is receiving in a nursing home or adult care home. For questions in Durham and Orange Counties call Jill Passmore at (919) 558-9401; in Wake and Johnston Counties call Nancy Murphy at (919) 558-2703; in Chatham County phone (919) 558-9404, and in Lee and Moore Counties call Aimee Kepler at (919) 558-2719. If you are in another county, call the Division on Aging at (919) 733-8395.