Save More Than Money – Save Your Life

The purpose of this column is to offer advice about saving money on prescription drugs – which usually reduces to asking questions of your physician and pharmacist. But, there are two other questions you should ask that can save more than money – they may save your life. These are the questions that may prevent prescription errors, and they should be asked before you say good-bye, before you leave the physician’s office, before you leave the pharmacy.

When your physician hands you a prescription, look at it, and read it. If it isn’t clearly written, so that you can read it with no difficulty, as “would you please rewrite this legibly?� You may not recognize the word, you may not be familiar with quadragintesimal either (it means “in forty parts� according to the Hutchinson Dictionary of Difficult Words) but you can read it, and that’s what’s important. Read the prescription aloud to your physician, to be sure you’re reading it correctly. If you can’t read the prescription, don’t assume that anybody else can, because an illegible prescription increases the risk that your pharmacist will make a mistake.

Physicians’ handwriting has been the subject of a lot of jokes – but when it leads to medication errors it’s not funny. Too often, drug names, when written, can look alike. One of the classic examples was Lasix (a diuretic) and Losec (to reduce stomach acid). Amrinone has been confused with amiodarone, hydroxyzine with hydralazine. A well written prescription should really have a lot more information than most of them do. Ideally, the prescription should have the patient’s name, gender, age and diagnosis. You want the pharmacist to have enough information to do a proper double check on the physician, to confirm that the MD didn’t order an adult dose for a child, didn’t put a decimal point in the wrong place, didn’t confuse two drugs with similar names. Some day, there may be a computer system that will give the pharmacist all that information, and print the prescription legibly, but until then, just make sure that you can read the prescription yourself. Sloppy handwriting can turn OD (once a day) into QID (four times a day), or QOD (every other day). It takes just a few extra seconds to make sure that the prescription is legible, and if it isn’t, to ask your physician to rewrite the prescription to prevent an error.

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When your pharmacist hands you a filled prescription, and this applies mostly to refills, take it out of the bag, open the vial, look at the tablet or capsule, and if it doesn’t look familiar, ask him to double check that it was filled correctly. You can even ask him to show you the stock bottle, the one that he dispensed from, to verify that it’s the right drug.

One of the most important advances in keeping drug costs down was generic dispensing. Generic drugs are as good as their brand name equivalents, and a lot less expensive. The disadvantage is that because the same drug from different manufacturers won’t look alike, you can’t identify a drug by its appearance. One month, a drug may be a round tablet, and the next month an oval tablet. One month, it may be a blue capsule, and the next month it may be red. Most of the time these changes in appearance will be the result of buying the drug from different manufacturers – but every now and then, it will be because the pharmacist grabbed the wrong bottle from the shelf. The prescription may have been perfectly legible, and given the pharmacist all the information needed to double check that its’ an appropriate drug in the right dose, but that won’t help if he grabs the 10 milligram tablets instead of the 5 milligram ones. You may not know what the drug looks like the first time, but if it looks different when you go back for a refill, ask the pharmacist to double check. Most of the time, hopefully all of the time, it will be because the drug came from a different manufacturer – but check anyway. If the drug comes in the original manufacturer’s package, compare the manufacturer’s label with the pharmacy label, make sure they agree. An increasing number of pharmacies are using bar code readers to do this step, but do it yourself anyway.

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Most of the time, both physicians and pharmacists do everything right, and that’s good – but there are still going to be exceptions. Asking some questions can save money. Asking other questions can save your life.