Q: Having so many seniors on multiple medications has to complicate the issue of drug interactions.
A: It does. No physician or pharmacist can readily have within their memory the ability to evaluate all potential drug interactions. Certainly, through experience, we are aware that certain drugs shouldn't be taken with other drugs. And because of technical advances, we are able to have at our disposal the ability to evaluate a potential drug interaction through computer programs we use, so flags will go up. It is incumbent upon us to not only verbally advise a patient on a new prescription, but we have to provide written information to each patient on each drug that we fill.
Q: When it comes to prescription management for seniors, who ultimately pharmacist, doctor, patient is responsible?
A: Everyone. You cannot say, "It's not my job." Every health-care professional down the line has to provide that information. Because the pharmacist is usually the end of the line in providing a particular medication, and because a pharmacist is more accessible from a time standpoint, it's incumbent for us to provide good, useable drug information.
Q: Is there a legal aspect to this responsibility?
A: It is a legal responsibility. It's been mandated by OBRA-90 (Omnibus Budget Reconciliation Act of 1990) that we provide information we must counsel (the patient) by law.
Q: Are pharmacists also legally responsible regarding drug interactions or contraindications?
A: When they are known, we must advise on known drug interactions or contraindications. Where it is blatant that a particular food/drug interaction or contraindication could be present, we should ask the patient and then advise if there is a particular drug/food interaction. What's important is that these are all mandated things for us to provide. As we've all experienced maybe not firsthand but through the news often a medication will be made available to the public, and you just don't know what all the problems will be. Somewhere up the line, when the problems present themselves and as soon as we are aware they have been presented generally information will come down immediately from drug manufacturers or the FDA then we need to provide that information. All too often, because of the amount of drugs out there and their complexity, we sometimes find out later (about potential problems).
Q: What about the senior and his or her family?
A: We all have an active role in our own healthcare, and to think otherwise is not only foolish but outright wrong. We need to ask questions. We ask questions of the doctor, and until we understand the information that he is giving us, we ask more questions. We ask questions of the pharmacists. At any stage of the delivery of health care, people need to be in the know. Since the family has a proximate role to the person who is ill, I recommend to them that they get involved together. That way you'll get the most vigilance in terms of seeing what is most effective, to see if you are improving firsthand.
Q: Since cost is a driving factor for many seniors in procuring prescription drugs, does it make sense to go to different pharmacies for different drugs?
A: Every pharmacist and every pharmaceutical association will tell you it is ill advised to use multiple pharmacies. When you break the link of evaluating a patient's complete drug history, then you are removing the controls and the evaluation process [of] being able to watch what the patient is taking and advising accordingly.
Q: What about purchasing prescription drugs via the Internet?
A: I'm against it because you lose too much of the control of what could happen. You lose the control of what you're purchasing and what you are in fact getting. Is what's inside of that purple-and-green capsule which is the way my drug looks when I purchase it at my pharmacy the same ingredients? We all have heard about forged medications that don't contain either the proper amount or the correct ingredients.
Q: What are some safe ways for seniors to save money on their prescriptions?
A: Nowadays, it rarely matters [whether you] go to a chain over an independent or a deep discounter over a regular retailer. If they accept prescription drug cards, the price is dictated by the card and not the pharmacy. In my last evaluation, about 84 percent of people in a typical pharmacy have some type of third-party drug coverage. It doesn't necessarily mean it's part of a full insurance plan, but there are groups out there AARP and other organizations that people can get, free even, prescription drug cards so that they can have more controlled pricing. Pharmacists sign on to the schedule, which I have to say is very lean from the pharmacist's standpoint. They get us to sign on to a prescription reimbursement schedule that is very favorable to the patient, and it's fine to do that. For the other 16 percent, they now have the Medicare Part D program.
Q: What should a consumer look for in a pharmacy and a pharmacist?
A: Certainly the availability of a pharmacist to spend some time with them if need be. A pharmacy and this is now practically universal that has a good system of managing their drug history. Then it's the ability to cultivate a relationship with that pharmacy. It is having a good knowledgeable technician staff and having a helpful front-end staff to direct the patient to who they need to see at the pharmacy and get the information that they need from the pharmacy staff. If you do that, you're going to be comfortable with that situation, and that's part of health care. Cultivating a relationship with your pharmacist is vitally important.