code blog: tales of a nurse

Awhile ago, I read a post from The Angry Pharmacist about Wal*M*art's $4 prescriptions. I really felt for his point of view - after all, isn't W-Mart responsible for putting zillions of mom-and-pop stores out of business? And over the years I've heard about them skimping on their employee's health insurance. I've always had the impression that W-Mart is pretty much squashing "the little guy" out there with its giant yellow smiley-faced foot.

Of course I'd heard about their $4 antibiotics. Is that what they started with? Just antibiotics? I was unaware that they've expanded their $4 drug list considerably until this weekend.

My patient was in the hospital for heart failure. We got him all tuned up, the docs tweaked his meds a little, and I was all set to discharge him. While talking to the doctor at the desk, I learned that the reason the patient had landed in the hospital with heart failure was because he was noncompliant with his medications.

I stopped caring about patients complying with their treatments a long time ago. Well, maybe it isn't that I don't care. Maybe it's because I've never really seen anyone "shape up." I've educated patients over and over and over again about the importance of taking their meds only to have them bounce back a month or two later due to their noncompliance. People are human - the best you can do is educate. What they do with that education is up to them. You can lead the horse to water and all that.

Anyway, the doctor wrote seven prescriptions for the patient to have filled. He had already been taking some of the medications, but many others were new. After I went through each prescription, explaining what the medication was for, I put them on top of his discharge papers and went about unhooking him from the monitor, etc. He'd been plenty chatty all morning, but he was suddenly very quiet.

He picked up the seven scripts and then put them down again. He said he didn't know how he was going to be able to pay for all of them. He said his insurance did not cover prescription drugs. I didn't ask him, but I wondered if that's the reason why he was noncompliant.

I left his room and asked another nurse if she thought that one of the social workers could provide him with some resources to help him with this problem. She said she didn't know if they could or not, but why didn't he just go to W-Mart and get them filled there? I said I thought that it was just for antibiotics, to which she replied, "Um, no."

So I went to the internet, hopped on W-Mart's website and printed out the list of medications that are $4. I went through and highlighted every. single. medication. that he was prescribed. All 7 were on the list. I took the list in to him and his daughter and suggested that maybe they try W-Mart for their meds. They looked at me with deer-in-the-headlight eyes. I told them that I found every med on the list, and that barring any restrictions (some meds are priced higher in CA due to state laws, apparently), he'd only have to pay $4 for each drug.

They just stood there looking at me incredulously. I was starting to feel a little weird until they turned to each other and smiled. My patient asked if he had to sign up for something, or have a specific insurance, and I told him that I didn't think so from what I read on the website.

The relief in the room was palpable. Then they started calling me an angel from heaven and all that, so I had to admit that it wasn't my idea :)

Just for kicks, I looked up how much each medication would have cost otherwise. I admit that I have no idea if what I was looking at was at all comparable to what they cost off-line, but by using W-Mart he'd save well over $100 per month. I would imagine that that's a substantial amount of money for someone on a fixed income.

I'm not naive enough to think that money was the only factor in my patient's non-compliance. But I do know that he was perfectly happy taking the medications I gave him. He even inquired as to what each one was and what it was for, which is something I cannot say for the vast majority of my patients. The ones who are conscious anyway. So although I am not naive to reality, I am hopeful that his noncompliance was due to economic reasons and not apathy.

Before I sent him home, I walked with him and his daughter around the unit to see how he tolerated activity. When we returned to his room, his daughter remarked that he seemed to be walking faster than he had in a long time. He agreed and added that he didn't feel out of breath, either. Here's to hoping he stays that way for a long time.

I'm not sure what to think about this $4 per drug business. It obviously puts independent and other chain pharmacies at a distinct disadvantage. I am sympathetic to their situation, but it's hard not to feel good about someone's father, brother, uncle feeling better because the drugs they need are affordable for them. Thinking long-term, his compliance will also keep him out of the hospital, thus saving even more money and leaving healthcare resources available for the 90+ year old demented bedridden urosepsis patients that populate our unit. I wonder if W-Mart has a fix for that.

Oops, guess I let a bit of sarcasm slip out.