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A Dose Of Safety: Do Your Pharmacy Homework

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By MARY SHEDDEN

The Tampa Tribune

Published: May 30, 2008

Imagine buying a car based on convenience.

You'd shop for the car only at dealers located within a five-minute drive of home. You wouldn't dare ask the salesman any questions. He or she will ask a few of you and decide which car is the best fit. And the price? You'd find that out when you picked it up.

Sounds ridiculous, but that's how some people approach decisions about prescription medications. In fact, half of the 1,000 adults in a recent pharmacy safety survey said proximity to home was their top reason when selecting a place to fill their prescriptions. Priority No. 2? Price.

Retailers are well aware of this consumer attitude. Drugstores, located on nearly every corner around town, grocers and big-box markets such as Wal-Mart are pushing their convenience with high-profile campaigns in and outside their stores. Promotions touting hundreds of prescriptions priced at just $4 are all the rage.

Given today's weak economy and the growing need to conserve gas, it's no wonder price and proximity are priorities. But before you run off to buy, consider this: Since 2000, there have been more than 95,000 medication errors reported to the Food and Drug Administration. Experts hope a third priority - safety - gets added to your decision-making process.

"Right now we're choosing a pharmacy like our commute depends on it, not as if our life did," says Ken Farbstein, managing partner of Boston-based Patient AdvoCare and consultant for Parata Systems, a maker of automated drug equipment and software. Parata sponsored the prescription safety survey.

Medication errors happen for a number of reasons, including poor handwriting on a prescription, confusion over drugs with similar names or misunderstandings over proper doses. The FDA's Center for Drug Evaluation and Research reviews 1,400 reported errors a month, and it estimates many others go unreported.

Farbstein and others say there are several common-sense things patients can do to reduce the risk of medication errors and make sure they are getting the best - and most affordable - drugs available. Asking questions at the doctor's office and at the pharmacy is an important first step.

He admits many people are intimidated when it comes to challenging a doctor's recommendation, particularly if the patient is elderly. But it's worthwhile to make the time to ask and learn about the potential side effects of brand-name and more-affordable generic drugs.

"They should talk both with their pharmacist and a doctor about the financial and safety implications," Farbstein says.

The Pharmacist As Liaison

Sabrina Madabhushi, co-owner of the Tampa Medicine Shoppe on Florida Avenue, says a pharmacist should be a liaison between patients and physicians. She regularly offers to call doctors about a prescription once a customer realizes how much it costs.

For example, she called a doctor who had prescribed a brand-name medicine for osteoporosis. The maintainance drug included a $30-a-month payment, after insurance. Madabhushi researched therapeutic alternatives within the same class of drugs, found a less expensive drug and spoke with the woman's doctor. The doctor agreed with the pharmacist, and the woman now pays just $5 for the osteoporosis drug.

"Most people don't question anything," says Madabhushi, whose pharmacy primarily serves people with chronic conditions needing long-term medication. "Oftentimes, they just take the prescription from the doctor and go to a pharmacy."

Most trips to the pharmacy involve little or no interaction, the national prescription safety survey shows. Eighty percent of customers say they spend less than two minutes talking with their pharmacist when getting their drugs. And 45 percent don't talk to the pharmacist at all.

The drop-and-fill philosophy is particularly dangerous if consumers are using multiple pharmacies to make the most of special price deals, Farbstein says. He suggests that if you are buying drugs at a large retail pharmacy, you should make the extra effort to know a specific pharmacist so he or she is familiar with the drugs you get. Ask what shifts that pharmacist works and arrange your schedule so you can talk to that same person every time.

"A pharmacy can only record what it knows. A lot of people do have to economize. But compensate for that by knowing your pharmacist even better," Farbstein says. "Let them know what other medications you are on."

Many of the inexpensive medications promoted today are generic, or copy-cat, drugs. Generic drugs emerge once a brand-name drug's 20-year patent expires; they are created using active ingredients that are identical to the so-called pioneer drug. For example, Fosamax, the pioneer osteoporosis drug, expanded in 2008 to include generics.

The main reason for the popularity of generics is financial. Generics don't carry the burden of long-term research and development and thus cost far less. The generic industry trade group says generics cost at least a third less than brand-name drugs.

Madabhushi says some people question generics because of the cost. "We have some consumers who mistakenly assume that because of the huge cost difference that the generic is cheap, ineffective and not safe," she says.

FDA Tests Generics

Still, consumers almost always jump at the chance to buy generic. A 2005 study of 40 generic drugs entering the market showed that within the first year, people switched and picked generics over a brand-name equivalent 55 percent of the time, according to Duke University economists and Boston-based Analyst Group.

Today, 63 percent of all prescriptions filled are for generics, says the Generic Pharmaceutical Association. That's likely because nearly 8,730 of the 11,487 drugs listed by the FDA have generic equivalents.

The FDA tests and approves these copycat drugs based on what they call "bioequivalence." The look of the drugs and inactive factors do vary, and some critics - including patient advocates, physicians and pharmacists - are raising red flags about potentially harmful side effects. Though generics are similar in their active ingredients, they do not affect patients exactly the same as the brand-name drug, they say.

Groups such as ConsumerLab.com argue that inactive ingredients that affect a drug's release into a bloodstream can lead to dangerous results. They point in particular to their research of the generic equivalents for the antidepressant Wellbutrin. Complaints from the group and dozens of citizens prompted the FDA last month to issue a statement saying the generic drugs are therapeutically interchangeable, despite small differences in the pharmaceutical formulas.

In the last several months, generic drugs for Toprol - one of the nation's top brand-name antihypertension drugs - have faced repeated criticism from columnists Joe and Terry Graedon, who publish their "People's Pharmacy" column in newspapers and online. Specifically, they cite a slew of complaints about how generics trigger erratic changes in blood pressure and pulse.

"This is of concern because the rate at which a generic dissolves may affect the rate at which it enters the blood. If blood levels for a generic differ from that of its counterpart original, it may not perform the same way," the Graedons write on their Web site.

Concerns about generic equivalents are nothing new. National epilepsy foundations, for example, have been outspoken for years about how brand-name and generic anti-seizure medications react differently. Cardiologist groups also have spoken out against blood-thinning generics.

Generic drug associations claim that these complaints are spurred by brand-name pharmaceutical companies worried about their profits. Patient advocates encourage consumers to see if doctors involved in the debates have financial or research-based conflicts of interest.

Regardless, this debate explains why you should discuss prescriptions in detail with your doctor and pharmacist, says Madabhutsi, the Tampa pharmacist.

"Consumers have to make sure they realize the potential impact of their prescription," she says.

The implications really do go far beyond convenience. Ask what it means, in terms of your safety and, yes, cost.

And, just as you would do with a new car, kick the tires and drive around before you drive away.

4 Simple Rules For Handling Prescriptions

Common sense and a lot of curiosity can reduce the risk of medication errors at your local pharmacy. Here are some simple rules when dropping off and picking up a prescription.

Patient advocates and local pharmacists suggest you:

•Know your pharmacist. Use one pharmacy, if possible, and develop a relationship with a pharmacist who will develop an understanding of your medical history.

•Talk about affordable options. If you're low on money and think you can wean yourself to less medication, STOP! Pharmacists are trained to identify safe alternatives that may help when a prescription is too costly. Ask them if it's possible to switch medications or reduce dosage. With inhaled medications, they can make sure you're not using the device improperly and wasting medication.

•Read labels immediately. Don't assume a prescription has been filled with the exact same drug. Some pharmacists may substitute for a generic or "therapeutic equivalent" that is on the market. If it's different than expected, go back to the pharmacist and get details about potential side effects.

•Don't assume newer is better. If you're intrigued by commercials touting a new medication, don't assume it's the best option. Talk with your doctor and pharmacist about the biological and financial implications of a new drug.

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