Thursday, May 17, 2018
Doctors Perspective
The cost of medication

By Dr. Anthony Policastro
Most of the medication that I prescribe is for children with ADHD. There are two major categories of medication. One of those categories has over 10 different brands for the same basic drug. The other one has approximately seven different brands for the same basic drug. There are three other less commonly prescribed medications. That means that for any given patient I have a choice of about 20 different medications I can prescribe. What I tend to focus on is which medication will provide the coverage I need for that particular patient. I also pay attention to which medication will work the best for that coverage. What I do not focus on is how much the medication will cost the patient. That is primarily because I have no way of knowing. Every insurance plan has a different favorite drug. There is no way to know which insurance plan prefers which drug. If a patient tells me their particular plan has an issue with a specific medication, I would be glad to change it. However, they do not always do that. Since most of my patients have Medicaid as their insurer, that is the one I focus on. That works well most of the time, however, I have noted in the past that every January, Medicaid changes its drug list which creates a new learning curve every year. I am fortunate because I prescribe from only about 20 possible medications. Think about the physician who treats a variety of illnesses. There is a need to know which is the best medication for that particular illness, how the medication will interact with the patients other medications and if the patient might have an allergy to it. That usually leads to a choice of the most appropriate medication. It does not, however, lead to choosing the least expensive medication for that particular patient. That issue lies with the insurance company. Patients who have insurance plans that do not cover all medications need to be proactive. There are multiple reasons for this. The first reason is simple. If a medication is prescribed, the insurance company will tell you which similar medication can be prescribed more cheaply. Most physicians will have no problem changing the prescription. They just need to know that. A second reason is that most pharmaceutical companies have plans to allow patients to pay lower prices for their medication. I was recently contacted by a patient who is now an adult. I had not seen her for eight years. She called me when she was no longer covered by her parents insurance plan. She stopped her medications because they were too expensive. She still needed them so she was having problems. I put her in touch with the company who cut her monthly costs by 75%. Some Medicare patients do not have Part D prescription drug coverage. Their physician knows they have Medicare but has no way of knowing that they do not have other coverage. That should be discussed before the patient leaves the office. They should not wait to get to the pharmacy to find that the medication is too expensive. That then involves more of their time, the doctors time and the pharmacists time. It is not really fair to others. Prescribing medication is complicated and involves a number of decisions. Cost of the medication is low on the list from a medical standpoint. It is up to the patient to make sure the physician knows about cost issues when the medication is too expensive.

Diabetes support group Nanticoke Memorial Hospital hosts free diabetes support groups on Mondays four times a year from 5 to 6 p.m., in the Medical Staff Conference Room. Pre-registration is required. 2018 schedule- June 18 The ABCDs of Diabetes with Medicare with Lakia Turner, community relations officer, State of Delaware September 17 Move with Jonathan with Jonathan Souder, MS, fitness director, Manor House December 3 The Dish on Diabetes - Learn food preparation skills for simple, savory diabetic dishes. For more information or to register, contact Nanticokes Diabetes Education department at 629-6611, ext. 2288.

Survive & Thrive 5K Walk/Run Celebrate cancer survivors one step at a time, at Survive & Thrive 5K & Survivors Mile, on Saturday, May 19, at Stango Park, in Downtown Lewes.

Cancer Support Community Delaware (CSCDE) will host their 4th Annual Survive & Thrive 5K, to kick off National Cancer Survivors Day which is June 3. Participants can join as a team or as an individual. The Survivors Celebration will feature a live radio broadcast by Radio Rehoboth, a K-9 demonstration, vendors, food, and a raffle. For more information and to register, vista All groups who sign up for the 5K with 10 or more people will receive a discount. Call 302-645-9150 or email for the code. All proceeds benefit Cancer Support Community Delaware.

Bariatric support groups Nanticoke Weight Loss & General Surgery hosts free bariatric support groups three times a month at the Nanticoke Training Center in Seaford. These support groups provide education and support to patients before and after their bariatric weight loss surgery and are open to the public. Support group meetings consist of guest speakers and presentations to provide information about nutrition, supplements, exercise and behavior modifications. Patients and their spouses, family members or friends are welcome to attend. Registration is not required. The general bariatric support group is open to all bariatric patients before and after their surgery and is held monthly on the first Monday from 5:30 to 6:30 p.m. and the fourth Monday from 6 to 7 p.m. The post-op bariatric support group is designed for post-op bariatric patients and is held on the second Tuesday of each month from 6 to 7 p.m. For more info about these support groups or other services provided by Nanticoke Weight Loss & General Surgery, visit or call 536-5395.

Squelching skin cancer: detection and prevention As summer is approaching, everyone needs to be aware of the dangers of the suns ultraviolet rays. On Friday, May 18 at 3 p.m., please join Lawrence Chang, MD, a Board Certified Plastic Surgeon and Dermatological Surgeon of Rehoboth Plastic and Dermatological Surgery to learn the importance of skin cancer vigilance. Dr. Chang will speak on detecting and identifying skin cancer, as well as methods to prevent skin cancer. This educational and informational program will be held in Tunnell Cancer Centers Conference Room on the ground floor of the Medical Arts Building. Moving With Melanoma will be on hand with information. Please register at 645-9150 in advance to reserve your spot in this free workshop. All programs offered at Cancer Support Community are offered free of charge to people affected by cancer and their loved ones. The Sussex facility is located at 18947 John J. Williams Hwy., Suite 312, Rehoboth The Cancer Support Community is part of a national nonprofit organization that provides support, education and hope to people with cancer and their loved ones. Through participation in professionally led support groups, educational workshops and mind/body classes, people affected by cancer learn vital skills that enable them to regain control, reduce isolation and restore hope regardless of the stage of disease. At the Cancer Support Community Delaware, all programs are free of charge. More information about the Cancer Support Community is available on their website at

Alzheimers Programs Easter Seals, 22317 N. DuPont Blvd. in Georgetown, is hosting a series of educational programs presented by Jamie Magee, coordinator for the Alzheimers Association. The following free programs are being offered: Friday, May 18, 10 a.m. Noon - Memory Loss, Dementia and Alzheimers The Basics. Register by May 13. Wednesday, June 6, 10 a.m. Noon - Effective Communication Strategies. Register by June 2. Friday, June 8, 10 a.m. Noon - Understanding and Responding to Dementia Related Behaviors. Register by June 5. Friday, June 22, 10 a.m. Noon - Healthy Living for your Brain and Body. Register by June 15. To register, call 800-272-3900 or email Sharon Jarnette at