Thyroid Patients: Dealing With Your Pharmacy and Pharmacists

pharmacist, pharmacy, thyroid medications
A good relationship with your pharmacist can be helpful to your overall thyroid treatment success.

We don't always think of it, but one of the crucial players in any thyroid patient's overall path to wellness is the pharmacy, and the pharmacists you work with to get your prescriptions filled. They are a critical step in the process, and are the middlemen between your doctor and you, in terms of the medications you are prescribed. This means that it is particularly important that, as a savvy thyroid patient, you ensure that you have a good relationship with a reputable, reliable pharmacy.

Here are a few pointers to help ensure that you are getting the most out of your pharmacy.

Compare Prices: Copay versus Actual Cost

Recently, a reader wrote to complain that her pharmacist had told her that her insurance company would no longer cover the natural thyroid drug her doctor had prescribed. She was now facing a $80 copay per month to get her Armour Thyroid prescription filled, and was frantic. Knowing that the retail price for natural thyroid drugs typically runs less than $20 a month, I suggested that she ask the pharmacist how much it would cost if she did not put the prescription through her insurance, but paid out-of-pocket. It turned out that her prescription would only be about $18 a month.

The message: if your insurance company refuses to cover a prescribed medication, find out how much it will cost out-of-pocket. It may be cheaper to simply pay directly, and it's far less frustrating and time-consuming than trying to fight with a health insurer.

Be Price Savvy

For brand-name drugs, check the drug-company website or Facebook page to see if they have any coupons. Many drugmakers include coupons for a free month, or a discount on your first prescription, or coupons for refills that can help save you money.

If you are paying out of pocket, shop around to compare prices.

Compounding pharmacies in particular can have very different pricing structures, so it's worth comparing prices. Some discount stores -- like Sam's Club and Costco -- have discounted monthly prescriptions on certain drugs.

Cut/Split Pills When Appropriate

Some medications cost the same amount per pill, no matter what the dosage size of the pill. This means that cutting a pill in half, for example, can cut the costs dramatically. Ask your pharmacist if a drug you are taking comes in a larger size, and if it can safely be split (some pills can't). If your doctor prescribes the larger dosage pill, and you split pills, you may be able to enjoy substantial savings.

Be Safe When Using an Online Pharmacy

If you're thinking about using an online pharmacy, make sure it's a reputable pharmacy. Our Guide to Arthritis, Carol Eustice, has an excellent article featuring 10 Tips For Using An Online Pharmacy.

Always Point out Dispense As Written/No Substitutions Prescriptions

In some cases, patients need to be on a particular brand of a medication.
Patients who are sensitive to lactose, for example, and can't take Synthroid (which contains lactose), may get stabilized on Levoxyl, which is lactose-free. This means that this particular patient should not be substituted with any available levothyroxine, brand or generic. The doctor should write "Dispense as Written" -- abbreviated as DAW-- or "No Substitutions" on the prescription. But be sure that when you submit the prescription, you ask the pharmacist to make note of the doctor's special request.

Always Check Medication When You Receive It

When a new prescription is filled, you should always check it personally to make sure that (1) the right number have been included (pharmacies have been known to accidentally miscount pills) and (2) it is the correct medication. It's not enough to just look at the name on the bottle; look at the actual pills to verify that they are the prescribed medication. Pharmacy errors are, unfortunately, all too common, but knowing what your medication looks like, and making sure the prescribed amount has been included can help ensure that you're getting the right medicine.

Double-Check Electronic Prescriptions

A study found that 9% of thyroid patients studied had their brand name levothyroxine substituted with generic, or another brand, by the pharmacy when the prescription was transmitted electronically. It's not clear why e-prescibing seems to generate more substitutions than traditional paper prescriptions, but with more doctors automating their prescibing system, this is even more evidence that you need to double check your prescription at pickup.

Check the Price When You Pick Up Your Medication

Make sure that you check the price you are being charged for the medication. If you have insurance, make sure that you are paying your copay, and no more. Again, pricing and billing errors are common at pharmacies, and you need to be vigilant to help minimize errors.

Make Sure Your Pharmacist Knows All the Medications and Supplements You Are Taking

It's fairly common to have prescriptions filled at more than one pharmacy. This means that in some cases, your pharmacist will not know all the medications you are taking. Many pharmacies have built in systems to flag any possible drug interactions, but if you are having your prescriptions filled at different pharmacies, those systems will not work for you. Make sure that you regularly inform all the pharmacies you use about all medications prescribed to you. And don't forget to include over-the-counter medications, and any supplements, vitamins, and herbs you may be taking. There are a number of known interactions between supplements and prescription medications: calcium and iron, for example, can interact with thyroid hormone replacement drugs.

If You Use a Generic, Try to Ensure That You Get the Same Manufacturer

One of the criticisms of generic levothyroxine is that each manufacturer's formulation can vary from 95% to 105% of the stated potency. This means that if you get refills of generic levothyroxine, and they're coming from different manufacturers, you can face a challenge getting stabilized on a particular dosage. This fluctuation typically does not occur batch-to-batch with the same maker. So if you have a relationship with your pharmacist, and he/she can ensure that you will get the same manufacturer's generic with each refill, making it safer to use a generic levothyroxine. But if it's difficult for you to stabilize your thyroid dosage, or you are a thyroid cancer patient who needs to have your thyroid suppressed, and you can't ensure that you'll get the same generic maker with each refill, then generic thyroid medication may not be for you.

If You Use a Compounding Pharmacy, Make Sure They Are Reliable and Recommended

All compounding pharmacies are not created equal, and a prescription from a compounder is only as good as the ingredients they use, the formulas they follow, and the care they use to prepare custom compounded prescriptions. Make sure that if you are getting a compounded prescription filled that you are using a compounding pharmacy that comes recommended from trustworthy sources -- like your doctor. Doctors who prescribe compounded medications typically recommend a local compounding or mail-order compounding pharmacy they trust, so be sure to ask your doctor where to get compounded prescriptions filled.

Ask For Replacements When Necessary

If your medication looks unusual, or does not have its usual smell, you may have received a bad batch, or old/expired medication. Don't hesitate to return prescription medication that doesn't look right to the pharmacy, to ask for a replacement.

This can be an issue for thyroid medication during summer months, if a pharmacy is not properly storing the medication away from heat, or if the pharmacy has a power outage, or if you use a mail-order pharmacy and your delivery sits in a hot mailbox. Thyroid medications are sensitive to heat exposure. If you suspect your medication may have been damaged by heat exposure, don't hesitate to ask for a replacement.

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