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Dear Mr. Rawles,

Pat C.’s recent post regarding the acquisition of prescription drugs in quantity includes many good thoughts. As a pharmacist of more years than I like to admit, I feel compelled to add to a few of Pat’s points.

Pat mentions FDA restrictions on quantities of several types of medications, including some “powerful antibiotics, pain drugs, and highly abused drugs”. I’m unaware of FDA restrictions on dispense quantities of any drugs, except regarding a very small number of drugs with unusually high-risk of adverse reactions. These few drugs would rarely come into play in stocking for calamities. The point that I believe Pat is driving at involves the Drug Enforcement Administration (DEA) restrictions on “Controlled Substances”, which, as a matter of definition include drugs with addictive potential, such as the opiate analgesics (pain relievers), many anti-anxiety agents (Valium, Xanax, etc.), and the amphetamines and related substances used for treatment of ADHD. The Federal list of these agents can be found at the DEA web site, for those who have time on their hands and are not easily bored. Many states have added a few agents to their very own 10th Amendment (my attempt at humor) replication of the Federal list, so check with your local pharmacist about specifics. You don’t want to come off looking like a drug seeker! The methods suggested by Pat will attract a lot of attention if you innocently try to apply them to, say…. Tylenol #3 (acetaminophen with codeine – a Controlled Substance under Federal regs).

Also, Pat’s statement, “some generics don’t work as well as branded drugs” may breed confusion. Though there will be endless opinion-driven debates over this topic, the science, the FDA, and the overwhelming medical opinion at this point is that generic drugs rated as “therapeutically equivalent” to the innovator (brand name) product, can be used interchangeably without harm. Again, if you want specifics, you can Google (or, as I prefer, Scroogle) “FDA Orange Book”, where you will find all of the products that are “AB rated”, and thus approved (at least by the FDA) for interchange. Or, again, ask your pharmacist. Practically all commonly-available generic products are now listed as equivalent.

Okay…so I’m biased (I’m a pharmacist), but you may come off better asking your pharmacist about which tablets you can cut, than to ask your doctor. I think that I can safely say (without offending my friends that are medical doctors) that we pharmacists have a lot more time to study such things than most doctors!

Just my 2 cents worth! As always, thanks for all you do to help us live fuller live! – SH in GA

Dear Mr. Rawles:
Regarding yesterday’s article “How to Build a Deeper Supply of Prescription Medications”, I would like to suggest an alternative source for low cost prescriptions. When I was without medical insurance, I purchased prescription medications from AllDayChemist.com. This company is located in India. My experience was very good. My prescription cost $12/pill in the US, and $4/pill from India. The quality was fine, the service was great. They charged a flat fee of $25 to ship the package by air. Once I was comfortable with the quality and service, I started ordering larger quantities to amortize the shipping cost.

Best Regards, “+P+”

Hi Jim,

Just a note on how I got around this. I take a medication for GERD (a symptom of which is painful heartburn). I take one pill a day and my medical insurance will cover 100 pills at a time, and won’t let me get any refills before the 100 days is almost up. Around here, all pharmacy computers are linked to insurance companies, so there’s no way anyone could do what Pat C suggests in her article, unless it was ordinary OTC drugs. Anyway, I only pay $2 for prescription drugs, and a lot more otherwise, so I was heavily motivated to figure something out. So what I did was I told my doctor that 1 pill/day isn’t always enough, depending on what I’m eating, and asked if she could raise it to two pills per day? (Sometimes this is true anyway). She did, and now every time I go I get twice as many pills. As long as I remember to go get refills every 100 days, I’ll be able to build up a nice supply. This doesn’t work for a lot of drugs, as dosage is critical in some things, but it worked in this case. GERD is one of those things where you just keep upping the dosage until it goes away (to a point, and I’m well below that point).

BTW, I cautiously asked my doctor about prescriptions for other types of medications, such as antibiotics, just to have on hand in a medical kit. In a word, she said “no“. – RL in Ontario

James,
I can tell you as a retail pharmacist for a chain store that we do have linked data bases from state to state, but it is only within the chain itself.
A couple of thing you might want to considered when getting your physician to write that six month prescription is to have him write for a total quantity of ______# of tablets (fill in the blank with the total number of tablets you will need for that six months of medication). This will avoid problems with pharmacists who are limited by state law to dispensing only what the doctor writes for. In other words if your Dr, writes for 30 tablets they can only fill for that 30.

As far as tablet splitting, some good points were brought up. I’d just like to make sure every one understands that if a tablet is not scored do not try to split it. Pharmaceutical sales people have told me that manufacturers do not guarantee an “even mix” in unscored tablets.

Also don’t forget to take advantage of any special transfer offers (such as $25.00 gift cards) that are being offered for transferring prescriptions between companies and the $4 prescriptions being offered by Wal-Mart, Krogers and Rite Aid. Many companies will also match these prices if you ask. (But you must ask.) – D. S. in Georgia

Mr. Rawles;
Many insurance companies allow you to purchase a 90-Day supply of prescriptions by mail at a cost that is normally much less then three individual 1-Month prescriptions. We have been participating in this program for years and have saved several thousands of dollars. – CaBuckeye

Most well-prepared individuals with chronic health conditions want to keep a deep supply of medications on hand, in the event of disaster that would disrupt normal chains of supply. Medical insurance plans typically have a 30-day limit on the amount of medication that can be obtained at one time. There are various reasons for these limitations – medical complications, FDA regulations, and cost-containment by your insurance company. However, there are ways to get around these limits and build a deeper stock of meds as part of your survival
planning.

Multiple Scripts

Ask your physician to write several prescriptions, each of which authorizing six refills for each drug you need. You might have to explain why you need such a large supply so be ready with a non-political story – your rural location, concerns about getting snowed in, bridge or road washing out, extensive travel outside the US, etc. Then, go to different pharmacies to fill each script. Do not go to different locations of the same chain because the chain likely has a central computer that will flag multiple purchases of the same medication in a short period of time. Tell the pharmacist at each drug store that you want the whole batch filled at one time. You’ll probably have to pay out of pocket for the drugs but you’ll end up with a good supply of meds that you can start to rotate to keep your stock within the expiration dates. If you belong to a health plan and the pharmacy is a contracted provider of your plan, then you should get the discounted price for your order even though the plan won’t cover more than a 30-day supply. Ask the pharmacist about that.

Multiple scripts that authorize several months of refills will work for most drugs but the FDA has strict dispensing controls on certain meds such as powerful antibiotics, pain drugs, and highly abused drugs like Vicodin,Xanax, and Adderall. It is unlikely that your doc will write a script beyond the FDA-approved limits – it’s illegal. He’d lose his license to practice and could even go to jail. So don’t push it – if he says something about FDA limits, respect the situation. Even if you did get such a script it’s unlikely that you could find a pharmacy to fill it – it’s illegal for them to do so.

Generics Versus Branded Drugs

To keep your costs down, ask your physician for a generic version of each med as opposed to a branded drug. Branded meds are protected by Federal patents which is why they are so expensive – no other pharmaceutical company can market a branded drug until the original patent expires. (It was the Reagan administration that extended drug patents.) Branded meds typically have cute names like Allegra, Celebrex, Lipitor, and Valium. Generic drugs are copies of branded drugs that are no longer under patent and usually have a chemical name such as Ampicillin or Hydrochlorothiazide. Wal-Mart now offers generics for $4 for a 30-day supply; I recently heard of a major drug chain that will fill a 90-day supply for $10. At these low prices, it’s cheap enough to bypass your insurance company and pay out-of-pocket, which eliminates one level of control.

Some generics don’t work as well as branded drugs and many meds are only available in branded form (the patent hasn’t expired yet.) so you may have to stick with branded drugs even though they are more expensive. However, beware of “new and improved” branded drugs. Often, that means that the original patent has expired and the drug is now available as an inexpensive generic. Not wanting to lose its lucrative monopoly on the medication, the pharma company makes a slight change in the original formula and then files for a new patent. Several major branded drugs such as Lipitor will soon be off patent so do your research and ask your pharmacist.

Pill Splitting

Many drugs are available in different dosages, many of which come in tablet form that can be split in half. If you take a 20mg dose of a certain medication and a 40 mg pill is available, ask your physician if the pill can be split. [by cutting it in half at a grooved line–properly called a “score”.] If so, then have the doc prescribe the 40mg dose which can be split in half, doubling your supply. Combined with the multiple script strategy outlined above, you’ll have a nice stock of meds, each of which is double your actual dose. This works for both generic and branded meds but is of particular use if you need expensive branded drugs that you have to pay for yourself.

There are two important cautions about splitting your meds:

1) You must ask your physician about this since not all pills can be split. For example, some pills have time release coatings; if split, the dose is released into your body too quickly which could be dangerous or even result in death. Also, splitting doesn’t work with capsules. Ask your doctor before splitting pills.

2) Do not split pills until just before you need them. Keep them sealed in their original containers or packets and store in a dark, cool place. Keep them from freezing. Pull only enough pills from your stock for the next 30 days or so. Split one pill at a time, as needed.

Canadian Pharmacies

You can also order meds through Canadian pharmacies which offer lower prices than US outlets due to strict governmental price controls up there. I am unsure how large a supply they will fill for each order but I suspect that you could obtain several months at one time. However, you have to make sure that you are ordering directly from a Canadian pharmacy. There are many Internet sites that claim to be Canadian pharmacies but it’s impossible to know for sure whether you’re working with a legit outlet or a crook in Nigeria or the Ukraine. Do not respond to e-mails about cheap drugs – most of those are fronts for identity theft rings – they want your credit card number. Others will send you meds beyond their expiration date or even fake pills that are perfect reproductions. Beware of scams, especially with anything you’ll be putting in your body. If you are anywhere near the Canadian border, make the trip in person once or twice a year so you can personally visit the pharmacy and talk to the staff.