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how do you expect me to pay for this???

Posted

Specializes in ob/gyn med /surg.

i had a patient discharged with about 5 medications. the patient said to me, how do you expect me to pay for this? i know the ecomony is very bad , and i just don't know what to say when people say this to me. i have had this said to me many times. i just don't know what to say , for some reason people think i write the perscriptions and should help them pay for them. has this ever been said to you and what do you say? i wish i could help , but i can't.

Whispera, MSN, RN

Specializes in psych, addictions, hospice, education.

Paying for medications is a very difficult thing. There are some places that fill certain prescriptions for not much money. Sometimes not much money is still too much though. There's a store near me that will fill prescriptions for some drugs for free. People can get samples from doctors. Also, all drug companies have programs where people who can't afford their meds can get them for free. Check out http://www.needymeds.com That doesn't help the person who is discharged and has no money, transportation, or is still to sick to go on an errand to the pharmacy!

ohmeowzer RN, RN

Specializes in ob/gyn med /surg.

we had the program where you could get 3 days free and that was cut out . the ecomony is hurting our hospital. i do love your suggestions thank you

Medic2RN, BSN, RN, EMT-P

Specializes in ER, IICU, PCU, PACU, EMS. Has 15 years experience.

We normally have a social worker consulted prior to discharge who assists the patient with this type of situation.

Do you have a resource like that at your hospital?

pink85

Specializes in School Nursing, Pedi., Critical Care.

Does your hospital have a social worker that can help? What does the doc say that wrote the prescriptions? Are their generic alternatives? I work at a very large county hospital so our social worker can get a medication voucher to pay for patients 'important' meds.

eriksoln, BSN, RN

Specializes in M/S, Travel Nursing, Pulmonary. Has 15 years experience.

I have had it said to me. Many times. I put in for a stat Social Services consult and document it. After that, I suggest the pt. take the generic and give the educational form on how to save money when purchasing medications routinely. One of the best suggestions on that form was using the mail order system. You get your meds delivered to your door, get a 3 month supply and pay less overall than what you would have paid getting the script filled month by month (a lot too, about 30%).

Beyond that, although I feel bad, I dont let people make it my burden to budget their money. A lot of the people who said "I cant buy my medications" were admitted IVDA and smokers..........I gaurantee they dont put down the Marlboro so they can get the antibiotics. I know, I sound jaded, but I'd go crazy taking on other people's burdens for them. I can only help so much. I dont offer accounting services.

ohmeowzer RN, RN

Specializes in ob/gyn med /surg.

i asked the social worker to come up and she suggested ( and i find this dumb) maybe they have a relative they can barrow money from. good heavens i could say that. lol... useless .. i do think our social worker will be laid off next.. she does nothing..

Fact is for a lot of folks living paycheck to paycheck and don't prepare for retirement, medical expenses are tough no matter the economic conditions.

This hasn't been said to me as I am not a nurse yet, but I would probably just suggest they make payments over time if they cannot pay upfront for it, I'm sure they could also use visa/mastercard or borrow from relatives.

Your best bet might be say something along the lines of 'there are more important things than money'.

pagandeva2000, LPN

Specializes in Community Health, Med-Surg, Home Health.

I work for a city hospital where self pay patients can receive their prescriptions at our hospital for $2. Anyone with insurance is referred to outside pharmacies. Even with this, we have some that state they they cannot pay.

We also have difficulty with obtaining affordable Diabetic Glucometers. Our facility obtains glucometers from various companies which are given to the patients for free, but I never thought that was a good idea, because after they used the 10 free strips, they were back to where they started within a day. Sometimes, the companies would send a few packs of strips, other times, they didn't, because this is how the company profited.

Now, the Diabetic Care Manager discovered a company that sells the glucometer for $10, 50 stips for $20, 100 lancets for $5, control solution for $5 and we still get arguments. In fact, one of the patients reported me to her doctor because I didn't prove them with the free glucometer. When I explained to the doctor how this was counterproductive, she agreed.

Believe me, I KNOW that it is hard to care for a chronic illness, or even to obtain antibiotics, etc... However, I also believe that we have done all that we can humanly do in our hospital and if one compared the prices between what is paid by a non-insured person in an outside pharmacy versus what we have been trying to provide, they can take some responsibility for their illness. Heck, they are cutting down on our benefits as well. We are so tapped out because we take people whether they can pay or not that the well is almost dry.

coolpeach

Specializes in ER/Ortho.

You could send them to the hospital social worker who can help them find resources to pay for their meds. If you want to do something yourself you can help them apply for medicare, medicaid etc. You could also check into local resources, and make a list you could give patients. I know here in Dallas we have Parkland health clinics everywhere. Its very easy to qualify, and the co pay is only either $5 or $10 depending on the medication. In addition, walmart, has a lot of prescriptions for only $4 a month, and CVS $5 for a month supply. You can download a list of which meds are covered on their website, and look for the patient and let them know. I have also seen a lot of TV adds from the drug companies stating if you can pay for your medication then call we can help you. You might want to keep an eye for those, and write the number down to pass on to patients.

I am doing all those things, and I think its makes a big difference.

southern rn

Has 19 years experience.

Wal-mart has a generic prescription program for $4 dollars/each. K-mart has one for I believe $5. I am sure many of the other national chains do as well. There could be a possibility of changing a med to a generic common one to take advantage of this. I believe you can actually look on-line for a list of the meds covered on this;at least it used to be available. I used to carry one as a resource to give to pts. It might also be helpful to call the pt.'s doctors office. Many times they have samples from the drug reps they will give to someone in need to help them out. Telling someone to use a credit card probably isn't going to help in the long run, cause if you can't pay for one, you can't pay for the other. As our economy worsens, we will probably hear a lot more of this:(

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

I'd get an MSW consult. There are tons of resources out there to assist people with the cost of prescriptions.

kmoonshine, RN

Specializes in Emergency.

I consider this to be a part of my responsibility when discharging a pt. Just yesterday I had a little kid with strep throat and he was actively vomiting. The doc wrote a prescription for an antibiotic and zofran; I quickly looked to see if they had insurance, and they were self-pay. So, I told the doc to reconsider writing a prescription for an anti-emetic that was cheaper (the kid would probably end up back in the ED dehydrated, puking, and with a fever because they couldn't keep any meds or fluids down since they couldn't afford to take the nausea med).

Is it best practice to write a prescription for the newest "top-of-the-line" medication (even though a pt can't afford it)? Or, is it best to write a prescription for a cheaper medication that produces moderate results?

We have to consider affordability in th ED - otherwise, people will end up right back where they started (with us). This is not only bad for the pt, but it drives up health care costs for everyone.

Sometimes, the "best" medication isn't the "best" treatment for the pt.

I like to say to my pts "The doctor had originally written a prescription for a medication that normally costs $120 out-of-pocket - I let the doc know that you couldn't pay that amount, so the doc wrote you a different prescription for a med you can pick up at target for $4...how does that sound?" (it helps to put the before/after cost into perspective).

There are some people who will say that they can't afford to pay anything for their meds - whatever the cost may be (even if its $1.00). Its odd though, because the pt was somehow able to afford that pack of cigarettes in their pocket. Many people are happy to pay for their "wants" but grumble about paying for their "needs".

$4 Drug List (Target): http://www.rxassist.org/providers/documents/TargetGenericsProgramDrugList.pdf

$4 Drug List (Walmart): http://i.walmart.com/i/if/hmp/fusion/genericdruglist.pdf

Midwest4me

Specializes in A myriad of specialties.

I agree with the suggestion of a referral to a social worker.

i asked the social worker to come up and she suggested ( and i find this dumb) maybe they have a relative they can barrow money from. good heavens i could say that. lol... useless .. i do think our social worker will be laid off next.. she does nothing..

Your social worker needs to get her butt in gear or be replaced. Even if they did borrow the money from a relative, are they going to be able to continue that every month... no! Here in KY we have St. Vincent Depaul, which is sort of like Goodwill. They actually can get some prescriptions drugs at no charge, they have a list of certain drugs just like the $4 programs do, but it really helps. Our social worker actually speaks with the docs discharging the patients prior to discharge to assure that they aren't going to have problems with prescriptions. I really like the way we communicate with each other about that... a few days in advance they will discuss the discharge meds and have a plan already in place for the patient to go home on. No patient has ever had to say to me, on their way out the door, "How am I supposed to pay for this?"

BroadwayRN, ASN, RN

Specializes in ER. Has 4 years experience.

I hate to be the doubting Thomas in the crowd but do realize that some people are just yanking your chain.

I've heard this from ER patients only to see them leave in a Lexis or light up a cigarette as soon as they get in that BMW.

Some people don't like to spend money on anything that they don't think of as a luxury or a neccessity. We have one frequent flyer who is literally killing herself. She has no insurance and comes in with extremely high BP's and chest pain. She has been given numerous scripts for a generic BP med. $10 for a 3 month supply at several chain stores or $4.00 for a months supply. She says she cannot afford to get it filled. She smokes 2 packs of cigarettes per day.

If I truly thought she didn't have the money, I would give her the money to get it filled.

I realize that there are truly people who have to do without something else essential in order to pay for their prescriptions but I'd be willing to bet that quite a few are just trying to get something for nothing.

Docs I know give samples to their needy patients to keep them compliant and never write them a script unless its for a $4.00 generic.

llg, PhD, RN

Specializes in Nursing Professional Development. Has 44 years experience.

This would be a good topic for a staff meeting and/or a good project for your staff to work on. Your hospital can/should develop some teaching materials/handouts that would guide patients to helpful resources. Staff could also receive some education on the resources available and how they can respond helpfullly in such situations.

You could bring in Social Services, Pharmacy, and Physicians to the discussion to help reduce the costs of meds (generics, automatic referrals to Social Work, etc.). With the economic situation as it is, we all need to be even more aware of this problem and work on ways to help our patients get the meds they need. It's a good time to do some unit-wide or hospital-wide projects on this issue.

So ... speak up ... start the conversation ... volunteer to serve on a team that will address the issue ... and improve the situation for everyone.

Good luck.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

i have had this said to me many times. i just don't know what to say , for some reason people think i write the perscriptions and should help them pay for them.

I don't think patients necessarily believe that you write the prescriptions, or that you should help pay for them. They are simply verbalizing their distress and you happen to be the person listening.

Out-of-pocket medical costs are obviously a huge problem for many people. This was the case even before the current recession.

If your social worker is unfortunately as unhelpful as you've indicated, you might have to *direct* him/her with suggestions such as, "Can you please investigate what state prescription programs this patient might be eligible for?" or "What pharma company resources/programs do you have a list of?" Sometimes you have to push.

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