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Emergency Prescription Medication

January 24th, 2020
preparedness  [html]
In the comments on yesterday's post on planning for disasters people brought up the situation of medications. As with many things in how the US handles healthcare and drugs, this is a mess.

The official recommendation is to prepare emergency supply kits for your home and work that contain:

At least a week-long supply of prescription medicines, along with a list of all medications, dosage, and any allergies

Running out of some medications can kill you: running out of blood pressure medication (ex: clonidine, propranolol) risks strokes or heart attacks, running out of anxiety medication (specifically, benzodiazepines) risks seizures, running out of insulin risks a diabetic coma. For medications like these, a week's worth seems low to me, since the harm of not having them is very high and maintaining extra that you rotate through should be low cost.

Should be low cost, but is it? If I decide I want to stock an extra month's worth of non-perishable food and rotate through it this is just bringing an expense forward a month, and is relatively cheap. But that's not how it works with medication.

Let's say I go to my doctor and ask for an extra month's worth of my medication to keep on hand for emergencies, and they are willing to write a prescription. My insurance company isn't required to cover backup medication, so they don't, which means I'd need to pay the sticker price.

Now, the US health insurance system is a mess, and part of how it's a mess is that it's mostly not insurance. In the case of prescription drugs it is more of a buyers club. While an individual is in a poor position to negotiate with a drug company, an insurance company can often use its large membership to get lower rates. Many drugs are far more expensive when bought individually than when bought with insurance, so it's likely that my extra month's worth of medication would cost me much more than it would cost my insurance company. And that's in addition to my insurance not helping me pay for it!

This is also assuming that my doctor is willing to write the prescription. If I'm on benzodiazepines, which are a controlled substance, my doctor would probably get in trouble for writing that prescription. Legally, there's nothing I can do except get every refill on the first day it's available.

If you read patient discussions you see some strategies that are probably not legal:

  • Refilling slightly early each month and building up a surplus (doesn't work with controlled medications).

  • Getting the doctor prescribe a higher dose, but continuing taking the lower dose and saving the difference.

  • Skipping some days or dividing a dose to build up some slack.

  • Buying the medication from sketchy foreign websites.

The medical community is aware of this problem (ex) but policy here, especially for controlled substances, is pretty limiting.

It's hard for me to think of solutions here when the drug policy I'd advocate is substantially less restrictive than the status quo, but for people who have a decent chance of dying if their medicine is interrupted this is clearly not a reasonable approach.

What do other countries do?

Comment via: facebook, lesswrong

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