Pay the cable bill, or get your prescription refilled?

REGION – The current recession is forcing area residents to examine their dollars and prescription drugs more closely. Local trends show patients leaning toward generics and alternative forms of treatment.

Although sales of prescription drugs typically are unaffected by the ebb and flow in the economy, this recession is having an unusually negative impact, according to a recent report by health information company Wolters Kluwer Health.

Nationally, according to the report published recently in the Wall Street Journal, patients did not fill 6.8 percent of the brand-name prescriptions their physicians ordered in the fourth quarter of 2008 because of cost. That figure is a 22 percent increase over the first quarter of 2007.

Are local pharmacies noticing the trend?

"There's no doubt it's happening," said Jim Bock, president and owner of The Prescription Shop. "I see it in my business. While I may fill the same number of prescriptions, at times the total dollars are less."

He operates five stores in the Traverse area.

"I'm sure there's some of that going on right now, but it's hard to gauge. Our sales do reflect a little bit of a decrease," said Lisa Debolt, pharmacist at Thompson Pharmacy on Union St. in downtown Traverse City.

Co-payment plans for prescription drugs have monetarily accelerated and become more "creative" over the decades.

"It used to be, when I started out 18 years ago, that people had $2 co-pays. Now, in the last few years it's gone to a $20 co-pay. And now, it's even more creative. You might pay $40 for a brand name and only $10 for a generic. There's even a third tier that might be like a $55 co-pay. It's makes people look at the other options," said Debolt.

The study also found that insurers are denying coverage of brand-name prescriptions when a less-expensive alternative is available. Furthermore, Bock says some people are very willing to switch to a cheaper alternative.

"People that used to insist on the branded product are no longer doing that. There's a trend to switch to generics very willingly by the consumer," said Bock. "I'd say about 68 percent of our dispensary is for generic drugs and as much as just 18 months ago that may have been about 56 percent. That's a pretty sudden change."

Nationally, the study found that patients did not fill 4.1 percent of generic prescriptions during the fourth quarter of 2008. Generic prescriptions increased to 2.4 billion in 2008, up 200 million compared with 2007, while orders for brand-name medicines declined by 200 million for 2008 to 1.4 billion, the study found.

"We don't know how much is attributed to the economy or how much the insurance companies are pushing consumers toward mandatory mail-order plans. Those plans draw people out of our community as well," Debolt said.

"Things are being shipped out to Ohio or Arizona to a mail order house. That's obviously going to affect the number of prescriptions filled locally," Bock said.

Michigan's state border is not the only border crossed when it comes to shopping for prescription drugs.

"People might look to Mexico, for example, for anti-cancer drugs that aren't legal in this country," said Bock.

"And a lot of people are ordering from Canada and elsewhere. That's been going on for years," said Debolt. "The problem is that there's also a lot of counterfeit stuff going on. So, you're not even sure what you're getting. The stuff people buy from Canada, for example, does not go through the same secure process. That's a worry for me, plus it's taking money out of our own community and state."

Right inside Michigan's state lines is another large competitor for locally-owned pharmacies. Consumers are, for example gravitating toward Wal-mart's $4 generic program.

"So while their numbers may be up, Sixth Street Drug, Thompson Pharmacy and I may be flat," said Bock regarding the big box competitor.

Another reason discussed was that people are just not getting them filled, unless they really feel that it's absolutely essential. Clients are cutting out drugs for cosmetic purposes or lifestyle issues.

"Perhaps that's the easiest place for people to hold back from spending money," Bock said. "People might try an alternative route because current therapies just aren't as effective for them. Or they might say, 'Do I want to get stuck with VicodinĀ® and then develop a habit for my back pain, or maybe I want to go to an acupuncturist or a chiropractor?'"

"A lot of people have tried medications and then find that it's not for them anymore," added Katherine Roth, MD, at Brookside Family Medicine on Front St. in Traverse City. "As things become more expensive, I would hope that people start to look at other options, but most people's insurance will pay for a drug and not a natural remedy. People are very frightened to have debt. I think behaviors are changing."

Chris LaBranche, who works in Health & Beauty Customer Service at Oryana Natural Foods in Traverse City, said people come to Oryana every day looking for supplements and alternatives (see top 10 list).

"The catalyst for a change is usually that first big medical bill," he said. "They're tuning in to the fact that they need to make lifestyle changes to improve their level of health."

Both Bock and Debolt's stores offer many quality supplements over the counter, as well.

"We carry supplements that help with cholesterol, blood sugar. But a lot of those that we stock are not necessarily less expensive than what the medication would be. But, it may be a healthier lifestyle," said Debolt. BN