Considering a visit to a retail health clinic? – National Consumers League

Retail health clinics have been popping up all over the United States in recent years. Many consumers find them appealing for their conveniences, but critics question the quality of care and are concerned about their impact on the traditional doctor-patient relationship.

As the United States is facing an increasing shortage of primary care physicians, Americans are turning to other sources of primary care. One delivery model that has attracted growing attention is the retail clinic, which focuses on providing convenient and accessible services at lower, easy-to-understand costs. These clinics are expanding rapidly across the country, from fewer than 100 in 2005 to thousands today.

These clinics are typically located in large retail settings, such as drug stores or big box stores. They are staffed largely by physician assistants or nurse practitioners, who can write prescriptions and have phone access to physicians. The growth of retail health clinics has been limited to parts of the country with legal frameworks that enable such clinics to deliver care and prescribe medication. The care offered through these clinics is restricted to a limited number of generally minor and easily treatable illnesses such as strep throat or urinary tract infections. Retail clinics often provide school and camp physicals, flu shots, and cholesterol checks.

The growth of retail clinics in America has generated debate on how they deliver health care to the consumer. The retail clinic provides convenience to the consumer by with extended weekend hours, central locattions, and fast service with an average wait time of less than 15 minutes – with no appointment necessary. Also many of the clinics post the cost of their services clearly for patients. However, critics argue that there are problems with quality of care due to staffing issues, continuity of care, and there is concern about how the clinics might impact the traditional doctor-patient relationship.

As retail clinics expand, state legislatures have taken a variety of approaches to regulating them. Some states are expanding the scope of practice for nurse practitioners, while others are moving for greater involvement by physicians. A handful of states require that physicians be on-site to support the nurse practitioners. Still other states such as Pennsylvania and California have called for expanding the scope of practice of nurse practitioners, including increased autonomy at retail clinics. Many states have seen bills aimed at additional regulation of clinics. Specifically, a few states have proposed laws restricting clinics by prohibiting the provision of medical services where tobacco is sold.

Given the complexities of the issue, we believe stakeholders will benefit from the opportunity to engage in an open and balanced discussion. NCL has found that multi-stakeholder forums help both consumers and policy makers navigate complex issues. Along with a final report on the forum, NCL will develop consumer education, including factors to consider when visiting a retail clinic. NCL will also summarize the issues state and federal policy makers and regulators should be considering as clinics expand. The report and consumer education pieces will be posted to the NCL website, and NCL will distribute the report to appropriate policy makers.

Thinking about visiting a retail health clinic? Start here with these FAQs

When should I use a retail health clinic?

Retail clinics are designed for providing basic services – cold, flu shot, strep test, etc. Retail clinics are intended for non-emergency and non-urgent use. Often a nurse practitioner or physician assistant provides the care.

Will my health insurance cover my visit to a retail health clinic?

Contact your insurance company to determine if the services are covered BEFORE you go. Ask the retail clinic if there are any other fees. Oftentimes, the fees-for-services are listed as they will be charged, while other times additional procedures might result in additional fees.

How will I know whether a clinic is legitimate?

The Convenient Care Association certifies its member clinics based on a variety of conditions, but not all retail clinics are members of the Association. You have the right to know whether or not a clinic and its practitioners are legitimate. Check to see if the clinic – or at least its practicing providers – are accredited or certified and don’t use their services if the clinic is not certified. Don’t be afraid to inquire about the practitioners’ licensing and certification to ensure that the clinic is legitimate.

What should I tell the retail clinic?

Be sure that you provide whoever cares for you with a detailed medical history – any conditions you may have, medications you may be taking, reactions to medications, past surgeries, history of treatment for disease, allergies, etc.

What should I tell my primary care provider?

Be sure to communicate back to your doctor anything that was prescribed or diagnosed while at the clinic. Get a report form the clinic and take it back to your doctor. And if you take a child, always report back to your pediatrician.

What if I don’t have a primary care provider?

Many of those who visit a retail clinic report that they do not have a primary care provider.

While a retail clinic can provide some basic services when you are in a pinch, it is best to have a primary care provider who knows and understands your entire health history and not just a single condition or ailment.

My health privacy – National Consumers League

The Health Insurance Portability and Accountability Act (HIPAA), along with its implementing regulations and subsequent rules that build on HIPPA, create a national standard for medical privacy. These privacy laws give patients greater control over their personal health information. Healthcare providers — including doctors, dentists, pharmacists, psychotherapists — as well as hospitals and most health plans, must adopt and follow policies to safeguard the privacy of your health information.

Below is an overview of consumers’ rights under health privacy laws. Learn what you can do if you believe your rights have been violated. If a health provider or plan is found to be in violation of the law, they may be subject up to $50,000 per violation with an annual maximum of $1.5 million, and one to ten years in prison. For information on how to file a complaint and additional resources, see the complaint form and other resources at the Center for Democracy and Technology.

Use of Health Information

The health privacy law sets limits on how health providers and plans may use individually identifiable health information. Under the law, health providers and plans may use your individual health information for treatment, payment, or healthcare operations without obtaining your permission. Personal health information may generally not be used for purposes not related to health care. And the release of health information must be limited to the minimum amount necessary for the purpose of the disclosure.

Notice of Rights

You must now be given a notice of your privacy rights when you see your doctor, dentist, pharmacist, or any other healthcare provider. The notice explains how your health information will be used and also tells you about your privacy rights. Providers are required to make a good faith effort to get you to acknowledge that you received the notice or your privacy rights by signing it, but you are not required to sign the notice.

What are my rights under the privacy regulations?

  1. You can inspect, photocopy, and request corrections in your medical records. Medical records include doctors’ notes, x-rays, and lab results. Photocopies of the records must be provided within 30 days of a request.  Your health care provider can charge you a “reasonable fee” for copying the records.  If your provider uses electronic health records, your electronic record must be transmitted directly to you upon request.
  2. You can find out who else has seen your medical records. At your request, doctors, hospitals, and health plans must disclose who has seen your medical records.
  3. If you are admitted to a hospital, you have the right to not have your name and health status be made publicly available through the hospital. If you choose to opt out of the hospital’s directory, the hospital will not confirm that you are a patient to outside callers. If you are listed in the directory, the hospital will disclose your general condition to callers who ask for you by name.
  4. Mental health providers must obtain a patient’s voluntary authorization before disclosing notes to health plans. Before the privacy law, health plans could access psychotherapy notes to justify further treatment.
  5. Your healthcare provider and health plan are not allowed to disclose any identifiable health information to your employer.

Can my doctor or dentist office use a sign-in sheet or call out the names of patients in the waiting room?

No. Sign-in sheets can be used, as long they do not ask the reason for the visit or display medical information. Any incidental disclosures of information are permitted, such as hearing the names of other patients in the waiting room, or seeing names on a sign-in sheet. The health care provider must have reasonable safeguards in place to protect health information.

Must hospitals and doctor’s offices provide private rooms and soundproof walls to avoid the possibility that a conversation is overheard?

No. While health providers must have in place appropriate safeguards to protect health information and make reasonable efforts to prevent disclosures, facility restructuring is not required. Examples of modifications that may be needed to safeguard health privacy include: use of cubicles, dividers or curtains in large health clinics to separate the areas where health professionals talk to patients; pharmacies asking waiting customers to stand a few feet back from the counter used for patient counseling; and doctors using discretion when talking to a patient who shares a hospital room.

Can I have a friend or family member pick up a prescription for me?

Yes. A pharmacist can use professional judgment and common sense to make sure it is in the patient’s best interest to allow another person to pick up a prescription. If a friend or relative comes to the pharmacy to pick up your prescription, that means they are involved in your care. You do not need to give the pharmacist the names of such persons in advance.

Can I communicate with my doctor by phone or e-mail, and can appointment reminders be mailed to me?

Yes. Health care providers can communicate with their patients at their homes through the mail, by phone, or in some other manner. If your provider phones and you are not at home, messages can be left on answering machines, or with a family member or other person answering the phone if a limited amount of information is disclosed. For example, leaving only a name and number or other information to confirm an appointment, or requesting that the patient call back. Email communication is encouraged, as long as a secure network is used and the messages are encrypted.

You can request that your doctor or health care provider communicate with you in a confidential manner, such as only getting calls at the office and not at home, or have any mail delivered in a closed enveloped and not as a postcard. If such requests are reasonable, your provider must comply.

Can my personal health information be used by marketers?

While HIPPA privacy law sets restrictions on the use of health information for marketing purposes, communications about treatment, disease management, wellness programs and health promotion are not considered marketing.

More specifically, the law requires that a person’s prior written authorization be obtained in order to use or disclose protected health information for marketing. However, the definition of marketing does not include communications related to health care. Communications that are not considered marketing include those that describe health-related products or services available to health plan members, those made for treatment, those more for case management or care coordination, and those made to recommend alternative therapies, providers or settings of care.

For additional information on the your health privacy laws:

Department of Health and Human Service, Office of Civil Rights

Center for Democracy and Technology

 

What consumers need to know about Rx drug substitution – National Consumers League

If you take prescription medication, there’s a good chance that someday you’ll be asked to switch from your current drug to a new one. There are many reasons, including costs to you or your insurer, changes in your insurance coverage, or new drugs coming on the market. Therapeutic substitution can offer benefits, but it can also pose risks. The key to ensuring your safety when making a switch is full transparency.

What do we mean by therapeutic substitution?

Here’s an example. Say you have acid reflux and have been taking omeprazole, a proton pump inhibitor to treat it, for several years. Because the cost of another proton pump inhibitor, lansoprazole, is less for your health insurer, your doctor is contacted by your health insurer and asked to switch you to another proton pump inhibitor, lansoprazole, in an effort to save costs.

The availabilty of another drug at a lower cost to your insurance program is one of the top reasons for therapeutic substitution. Among others:

  • Another drug is available to your insurance program at a lower cost.
  • A medication is no longer covered by your insurance program.
  • A cheaper medication is available.
  • You may be offered discount coupons on a different drug, or your doctor may be offered financial incentives for prescribing a particular drug instead of others. This is a practice that concerns some advocates, because it is important that when a switch is considered, your health is always the top priority.
  • Your doctor wants to switch you to a drug that may be more effective or a better fit for your needs.

How does therapeutic substitution happen? There are several ways:

  • Your health insurance company may contact your doctor and urge her to switch from the prescribed drug to another drug in the same therapeutic class.
  • Your health insurance company may contact you, the patient, directly to say you can save money by switching your current prescription drug (a brand name) to a generic version of a different brand name drug. The new recommended drug is in the same class as the one you’re taking, but it’s chemically different. Learn more about drug classes here.
  • Your health insurance company may call or write you to say that your current drug is no longer covered, and you should talk to your doctor about switching you to another drug in the same class that is covered. Otherwise, you’d have to pay out-of-pocket to stick with your current medicine.
  • In some health insurance plans, your doctor and pharmacist all follow the same coverage rules, which include a pre-approved list of drugs. If your doctor prescribes a certain drug that isn’t covered, your pharmacist could substitute it with one that’s on the pre-approved list. In this case, you might not find out that you’ve been switched until you go to the pharmacy.

 

Common therapeutic drug substitutions – National Consumers League

Therapeutic substitution, known also as drug switching and therapeutic interchange, is the practice of replacing a patient’s prescription drugs with chemically different drugs that are expected to have the same clinical effect. Many times patients switch to a different drug with no problems. However, for certain medications and conditions, therapeutic substitution could cause problems.

Consumers with a few specific conditions may be more likely than others to encounter a switch. Here are some of the conditions in which therapeutic substitutions may be more common, as well as the concerns about substitution expressed by some patient groups. As always, it is important to talk to your doctor about any potential therapeutic substitution.

In the lists of medicines, the Brand Name comes first, (and generic version is in parentheses).

Antidepressants 
Antidepressants stimulate chemical changes that increase the levels of neurotransmitters in the brain responsible for a person’s mood.

Some examples of antidepressants:
Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), and Lexapro (escitalopram). Antidepressants are associated with drug groups known as MAOIs, tricyclics, and SSRIs and are commonly prescribed by psychiatrists and other physicians to treat depression, bipolar disorder, and other mental illness.

Substitution concerns:
The American Psychiatric Association, Mental Health America, National Alliance on Mental Illness, and the National Council for Community Behavioral Healthcare oppose therapeutic substitution based on the substantial risk of serious adverse outcomes in people with mental illness. These groups support policies that provide patient access to the medications their doctors think they need, and they encourage shared patient-physician decisions based on the unique needs of individuals.

Cardiovascular Medications
There are several classes of drugs used to protect your heart, monitor your cholesterol level and blood pressure, and prevent other damage.

  • ACE inhibitors are used for controlling blood pressure, treating heart failure, preventing stroke, and preventing kidney damage in people with hypertension or diabetes. They also improve survival rates in patients who have had a heart attack.
  • Examples of ACE Inhibitors include: Capoten (captopril), Vasotec (enalapril), Prinivil (lisinopril), Accupril (quinapril) and Univasc (moesxipril)
  • Statins are used to lower cholesterol levels in people at risk of developing heart disease.
  • Examples of statins include: Lipitor, Zocor (simvastatin), Crestor, Pravachol (pravastatin), Mevacor (lovastin).

Substitution concerns:
The American Heart Association and the American College of Cardiology oppose therapeutic substitution and believe that only the prescribing doctor is equipped to determine the best drug or combination of drugs. These organizations believe that therapeutic substitution may result in the patient receiving a drug that doesn’t work well enough, produces life-threatening toxicity, or interacts dangerously with other drugs the patient is taking.

Epileptic medications
The drugs taken by patients with epilepsy are called antiepileptic drugs (AEDs) and are designed to change the electrical signaling in the brain to stop or prevent seizures. 

Examples of AEDs include:

Dilantin (phenytoin), Luminal (phenobarbital), Tegretol (carbamazepine), Neurontin (gabapentin), Lamictal (lamotrigine), Gabitril, Keppra, and Zonegran (zonisamide).

Substitution concerns:
The Epilepsy Foundation is concerned that there are enough differences among AEDs that any kind of medication substitution, (including switching from brand-name to generic), could be dangerous, and it could result in less control over seizures. The Epilepsy Foundation says that changing from one drug formulation to another can usually be done successfully if the patient’s blood levels, seizures, and toxicity are carefully monitored, but it says any medication change must require the permission of the treating doctor and the patient.

Proton-pump Inhibitors
Patients with dyspepsia, peptic ulcer disease, or acid-reflux may be prescribed a proton-pump inhibitor (PPI), drugs that result in long-lasting reduction of gastric acid production.

Examples of PPIs include:

Prilosec (omeprazole), Prevacid (lansoprazole), Nexium.

Substitution concerns:

As with any substitution, it is important to talk to your doctor, and be aware of the benefits and risks of substitution.

Obesity survey: The disconnect between size and weight – National Consumers League

According to the Centers for Disease Control and Prevention, an estimated 66 percent of U.S. adults are overweight (33 percent) or obese (33 percent) but, according to a new National Consumers League study conducted by Harris Interactive®, only 12 percent of U.S. adults say they have ever been told by a doctor, nurse, or other health care professional that they are obese. 

Following the recent announcement by RAND Corporation, which notes that the prevalence of American adults who are classified with severe or morbid obesity is increasing at a much faster rate than the prevalence of moderate obesity, the National Consumers League today is releasing troubling new survey data about consumers’ misconceptions about their weight and knowledge of weight-loss options. NCL is also announcing new Web resources for consumers who may need to lose weight but don’t know where to begin the daunting process.The survey of 1,978 adult Americans, was conducted online by Harris Interactive from March 6th to 12th, 2007. NCL has launched a new consumer education campaign, “Choose to Lose”. The new materials available at www.nclnet.org/obesity aim to help consumers overcome the overwhelming task of honestly evaluating their individual weight and work with their doctor to do something about it.

‘Obesity’: Not Admitted by Most

NCL’s new survey found a startling disconnect between the way people perceive their weight, and their actual weight category based on the body mass index (BMI), the most common measurement for obesity. U.S. adults were much more likely to refer to themselves as “overweight” rather than “obese”, and consistently identified themselves as being in less severely overweight groups.  In fact, 52 percent of respondents referred to themselves as overweight, and only 12 percent as obese, severely obese, or morbidly obese. But, based on actual BMI calculations using self-reported height and weight information, among the 96 percent of respondents who reported height and weight, 35 percent are actually “overweight,” whereas 34 percent are actually obese, severely obese, or morbidly obese. Among respondents who are obese according to BMI, 82 percent consider themselves to be simply “overweight.” Alarmingly, only a minority of all respondents (20 percent) claimed to know their BMI number.

“This discrepancy between perceived and actual weight categories suggests that the stigma associated with being obese is a powerful one; many consumers would benefit from a more realistic picture of their own weight,” said NCL President Linda Golodner. “We wanted to find out how consumers feel about their weight, their health, their need to lose pounds, and the stigma surrounding treatment options. We found that while many consumers view obesity as a legitimate disease, they don’t want to identify themselves as ‘obese.’ Weight is a highly personalized, complicated issue, and many overweight and obese consumers are in need of help.”

Perceptions about Obesity: Real Disease, Real Treatment, Real Stigma

Despite the commonly held view that obesity is a serious disease, significant levels of cultural bias persist. Most respondents (78 percent) say that obesity is a serious, chronic disease and that it requires medical treatment (54 percent). Most U.S. adults (61 percent) report, however, that obesity is considered taboo in society today, and half (50 percent) attribute the condition to a “lack of will power.” More than a third of U.S. adults (37 percent) agree that obese people should pay more for health insurance, and more than a quarter (27 percent) say that it is still acceptable to make fun of obesity. And, although many U.S. adults were accepting of many different types of treatment (more below), ranging from diet and exercise to acupuncture, there are still some negatives associated with certain options. For example, although 79 percent of respondents say weight-loss surgery can be a life-saving treatment, half (49 percent) agree that there is a stigma associated with using surgery as a weight-loss option. Moreover, forty-seven percent held a very negative or somewhat negative view of weight-loss surgery.

“There is a serious disconnect between an individual’s perception of both what it means to be overweight and the health risks of carrying extra pounds. While many consumers know that weight loss can improve the illnesses associated with excess weight, they do not have the information to separate unsubstantiated weight-loss claims from evidence-based strategies to support their weight-loss efforts,” said Madelyn H. Fernstrom, PhD, CNS, Associate Professor and founding Director of the Weight Management Center at the University of Pittsburgh Medical Center. “Consumers need accurate information about the lifestyle changes they need to make to not only lose weight, but keep it off. Lifestyle change is the foundation of successful weight loss, but other treatment options, including prescription medications and surgery, can be added to help support—not replace—the lifestyle effort. When it comes to losing weight, one size does not fit all, and obesity treatment should be individually tailored, with careful consideration to both biological and behavioral factors.”

Personal Reflections on Weight & Weight Loss

According to findings, 64 percent of respondents are not happy with their current weight, and many say that more time to exercise (59 percent), better access to healthful foods (31 percent, and more time to cook and eat at home (31 percent) would help them achieve and maintain a healthier weight. More than three quarters (77 percent) of respondents have tried to lose weight at some point, and among these, 60 percent agree that it is one of the hardest things they have ever tried to do. Despite the attempts, many are unsuccessful at either losing weight or keeping it off. Less than a third (29 percent) of those who have ever tried to lose weight report being successful, and about a third (34 percent) have only been able to keep off the weight they lost for less than one year.

“I was fortunate to have a doctor tell me that I seriously needed to lose weight. But not all consumers who need that push from their healthcare professional get it,” said Peggy Kindler, a 51-year-old Pittsburgh, PA resident who has battled weight issues all her life. In the year since gastric banding surgery, Kindler has lost 53 pounds but continues to struggle with the challenges of weight-loss. “As someone who has experienced the very real benefits of losing a significant amount of weight, and being able to keep it off, I truly hope that these new materials for consumers at www.nclnet.org will help people recognize their weight problem, understand the weight-loss options available and motivate them to get help.”

Getting on Track for Weight Loss

About half (52 percent) of people say that they have talked about losing weight with their doctor, although respondents who are obese are more likely to have done so. Among those who have discussed weight loss with their doctor, nearly three in five (59 percent) report that their doctors recommended a diet change (47 percent) and/or exercise regimen (35 percent). However, only one third discussed the health risks associated with their weight, and only ten percent said their doctor helped them develop a plan to lose weight.

Of the weight-loss options other than regular diet and exercise discussed in the survey, respondents reported being most familiar with: organized weight loss programs (56 percent); over-the-counter medications (42 percent); weight-loss surgery (41 percent); and prescription medications (39 percent). Organized weight-loss plans also were perceived very or somewhat positively by most (69 percent) respondents, followed by counseling/psychiatry (55 percent), and intensive weight loss “camp” (45 percent). More than a third (38 percent) held a very positive or somewhat positive view of weight-loss surgery, while a third thought positively of prescription weight-loss medications (35 percent), acupuncture (34 percent), and hypnosis (33 percent).

About the Survey

The survey was conducted online within the United States from March 6 to 12, 2007 by Harris Interactive® on behalf of the National Consumers League among 1,978 adults aged 18+. According to BMI calculations out of this sample of 1,978, 25 are underweight, 528 are normal weight, 679 are overweight, 351 are obese, 164 are severely obese, 138 are morbidly obese. According to self-assessment 58 are underweight, 590 are normal weight, 1,032 are overweight, 180 are obese, 60 are severely obese, and 48 are morbidly obese. Figures for age, gender, race/ethnicity, education, region and household income were weighted where necessary to bring them into line with their respective total populations. Propensity score weighting was also used to adjust for respondents’ propensity to be online.

With a pure probability sample of 1,978 adults one could say with a 95 percent probability that the overall results would have a sampling error of +/-5 percentage points would have a sampling error of +/-3 percentage points.  Sampling error for data from sub-samples may be higher and vary.  However, that does not take other sources of error into account. The online survey is not based on a probability sample and therefore no theoretical sampling error can be calculated.

NCL thanks Allergan, Inc. for an unrestricted educational grant that made this survey and educational effort possible.

 

 

Aspirin and coronary vascular disease – National Consumers League

Aspirin is a very common medication. It can be used to reduce pain, fever, and inflammation. Aspirin has another important benefit: it can reduce the risk of another heart attack or stroke in a person who has already had one. Studies are being conducted to see whether aspirin can prevent a first heart attack or stroke; some doctors recommend aspirin to certain patients who are at risk.

To be effective in helping prevent a heart attack or stroke, aspirin must be used properly. Using aspirin for the prevention of coronary vascular disease (CVD) is very different from using it to treat a headache or fever.

Like all medications, there are risks when taking aspirin—including stomach bleeding and kidney, heart, and liver problems—when taken daily for weeks, months, or years. This Web site will help answer some basic questions about aspirin use for CVD. Talk to your health professional before taking aspirin for CVD prevention. Follow all directions on the label before you take any over-the-counter medicine. If you are not sure, or have any questions about any medication, ask your doctor, pharmacist, or other health professional. 

Questions and answers

Aren’t all pain killers/analgesics the same?

No. There are many types of pain killers/analgesics. They work in different ways in the body, and some are more appropriate than others for certain types of conditions.

How do I know which analgesic is right for me?

You should talk with your health professional (doctor, nurse, pharmacist) about the most appropriate medicine for your situation.

I heard that aspirin is effective in helping to reduce my risk of heart attack or stroke. Are any other analgesics/pain killers also effective?

Only aspirin (salicylic acid) has been proven to effectively reduce the risk of CVD. Many common analgesics contain other ingredients such as ibuprofen (Advil‘, Motrin IB‘), acetaminophen (Tylenol‘), and naproxen (Aleve‘, Naprosyn‘) that have not been proven to reduce the risk of CVD. Read the labels to make sure you are taking aspirin. Many products have more than one active ingredient, including aspirin.

Can I just take the same aspirin that is in my medicine chest at home?

A. You should consult with your health professional before beginning an aspirin-therapy regimen. There are many different varieties of aspirin products to meet your needs. For example, if you have gastrointestinal (GI) problems or are already on medication for GI problems, you may want to take an “enteric coated” (Ecotrin‘, Ascriptin‘) or “buffered” (Bufferin‘) aspirin to reduce your chances of stomach upset. Enteric-coated aspirin is specially designed to dissolve more slowly to avoid stomach upset. Buffered aspirin contains antacids to neutralize the acid in your stomach that causes upset. Read the label to make sure you are taking the appropriate product.

How many aspirin should I take to get the benefit? What is the right dose?

A. Studies have shown that a low-dose (81 mg.) a day is effective in reducing the risk of CVD and stroke. Most aspirins come in doses of 325 mg. or extra strength doses of 500 mg. Look for the product with the dose recommended to you by your health professional

Are aspirin products available in a low-dose form?

Yes. There are a variety of low-dose aspirin products available. Your doctor can recommend one for you. Some common low-dose products include Ecotrin‘ and Bayer‘. If you have trouble finding them at the pharmacy, ask your pharmacist to help you.

What about side effects or interactions with other medicines?

As with any medication, you should talk to your health provider about any and all medicines, including over-the-counter and prescription medicines and dietary supplements (vitamins, minerals, herbals) you are currently taking. Certain medications and dietary supplements can interact with aspirin and cause serious problems. Aspirin is a blood thinner. If you are on a blood-thinning medicine such as coumadin/warfarin or heparin, taking high doses of vitamin E or certain other dietary supplements (gingko biloba, ginseng, garlic, willow bark), check with your health provider. Always read the labels of all your medicines to check for side effect and interaction warnings.

Choosing the right eye care provider – National Consumers League

Choosing an eye care provider can be confusing! Optometrists, optometrists, opthalmalogists. It is important to understand the differences in education, training, credentials, and experience levels that distinguish one type of eye care provider from another – and what kind of services each specializes in.


Keep this in mind when selecting an eye care provider:

  • Know what your needs are when going to an eye care provider. If you don’t know what you need to have done, ask your primary care doctor.
  • Look for diplomas, licenses, and other qualifications and certifications displayed publicly at the office.
  • Ask the provider is he/she has sufficient training and experience to perform the procedure you need, especially when the procedure is more invasive than a regular office visit.
  • If your eye care needs include surgery or treatment with medications, ask your provider if he or she is trained and licensed to perform these services.  Ask how many times he or she has performed the service, and what kind of side effects and recovery time you can expect.
  • If you do not have access to or are unsure about the eye care provider you need, ask your primary care doctor for a recommendation to properly address your needs. 

What to ask yourself as you consider which eye care provider is right for you

What services do I need my eye-care provider to perform?

You should distinguish between the need for primary care (fitting of glasses and lenses), and more advanced care (serious conditions and diseases, surgery).

State laws and regulations specify what services an eye care provider is permitted to provide. While ophthalmologists, as medical doctors, can perform eye treatments including surgeries and prescribe medications, state laws and regulations vary for optometrists, who are not medical doctors. You should be aware of which services optometrists are authorized to provide in your state, and whether an optometrist is able to provide all aspects of treatment that is needed.

Visit the Association of Regulatory Boards of Optometry for a link to state optometry boards and information on the services an optometrist can provide in your state:

What credentials and qualifications does my eye care provider have?

Check to see whether diplomas, licenses and training credentials are posted clearly in office/waiting room. If this information is not posted, ask the practitioner if he or she is an optometrist (attended optometry school) or an ophthalmologist (attended medical school).

Terms used for eye care professionals can be confusing. For example, some optometrists refer to themselves and other optometrists as “optometric physicians.” Traditionally, only medical doctors or MDs are referred to as physicians. While optometrists offer valuable services, they are not medical doctors, and you should be aware of the difference in training and education.

Does my eye care provider have sufficient training and experience to provide the care I need?

While each member of the eye health care team is a professional with extensive training, you should know whether a provider has adequate training for and experience with the specific procedure or care that you need.

Questions to pose to an eye care provider might include: Is he/she on call if I have a problem at night or on the weekends? If not, who is available to deal with potential problems you might develop? Can he/she provide treatment in a hospital should that be required?

Does my eye care provider have sufficient training and experience performing surgery or prescribing medications?

Ask providers about their surgical training and the number of similar surgeries they have performed before making decisions regarding surgery.  Some questions you should ask include:  Where did they learn the procedure? How many times have they performed the procedure? What is the complication rate (the chance that a problem may occur) for the procedure?  What are the odds of success/failure?

Treatment of eye conditions and diseases often involves using prescription medication. The more prescriptions you receive, the greater your risk of drug interactions. Before prescribing, providers should ask you about other medications you are taking and any other medical conditions you may have. You should keep a personal medication list that includes all prescription medications, over-the-counter drugs (such as aspirin), vitamins and herbal supplements you are taking. Check this list with your provider to make sure there are no complications.

Do I have easy access to the eye care provider I need?

When considering access issues, you need to make sure that, in striving for convenience, you do not sacrifice quality. If you are seeking primary eye care, such as a vision check for glasses or contacts, the nearby optometrists could satisfy your patient care needs. If you are seeking advanced care, such as treatment for serious conditions and diseases, the extra time to access an ophthalmologist is likely worth the assurance of seeing a trained medical doctor.

Do I know how to report problems with my eye care provider to the proper regulatory authorities?

For optometrists, visit the Association of Regulatory Boards of Optometry.

For ophthalmologists, visit the Federation of State Medical Boards.

 

Eye care 101 – National Consumers League

Consumers have many choices of eye care providers: opticians, optometrists, and ophthalmologists. How do you know which kind of provider is right for your needs?

Eye care providers serve a broad range of patient needs, from fitting eyeglasses to performing invasive surgery, and all have different levels of education and training. Depending on the services you need, one type of provider may be more appropriate than another. In addition to the usual considerations of convenience, cost and established relationship, you should make a point to learn about the credentials, education, training, and experience of all eye care providers.

Meet the members of your eye care team

Here is a listing of the various members of the eye care provider team, what they do and their credentials. Opticians provide the most limited amount of service while ophthalmologists provide all services within the eye care continuum.

Opticians fit eyeglasses and contact lenses, following prescriptions written by optometrists or ophthalmologists. They measure patients’ eyes, recommend eyeglass frames and lenses based on the patient’s needs and can reshape eyeglass frames to fit properly.  When licensed to do so, opticians also can fit contact lenses.

Credentials:

  • They are licensed (required in twenty-one states) after they have earned either an associate opticianry degree (one- to two-year program), or after they have apprenticed for at least two years.
  • They must pass a licensing examination and some apply to the American Board of Opticianry for certification.  Certification is awarded after passing an exam, and must be renewed every three years.
  • In some states, opticians must pass the National Contact Lens Examination to dispense contact lenses.

Optometrists provide routine, primary vision care.They examine eyes to detect vision problems such as nearsightedness, farsightedness and astigmatism, and diagnose eye diseases such as glaucoma. They also test patients’ depth and color perception, as well as their ability to focus and coordinate eye function.  Opticians prescribe eyeglasses and contact lenses, and in some states administer and prescribe medications to help diagnose vision problems and treat certain eye disease.

Credentials:

  • All states require optometrists to be licensed.
  • Optometrists must have a Doctor of Optometry degree that requires a minimum of three years of undergraduate studies at a college or university, followed by four years at an accredited optometry school.
  • They must pass both a written and clinical state optometric board exam in order to receive a license, required by all states.
  • They are regulated at the state level, and must report to a state board of optometry for their license renewal (usually every three years). 

Ophthalmologists are medical doctors who specialize in all aspects of eye health. They provide primary eye care services including eye exams and prescribe medications and perform surgical procedures, such as laser surgery and lens replacement. Using both surgical and non-invasive techniques, ophthalmologists diagnose and manage eye diseases, conditions, and disorders, and treat and repair eye injuries.

Credentials:

  • All states require ophthalmologists to be licensed.
  • Ophthalmologists must have a college degree (or minimum of three years of college), four years of medical school, a one-year internship, and at least three years of an ophthalmology residency (hospital-based training). They must then pass a licensing examination.
  • As medical doctors, ophthalmologists are regulated by state medical boards

Speak the language of your drug coverage plan – National Consumers League

If you’re facing the opportunity to choose a new drug coverage plan for you and your family, you need to speak the language in order to weigh the costs and benefits.

Brand name (drug): A one-of-a-kind drug that is still protected by a patent.

Co-pay (or co-payment): A fixed amount, for example $10, that an insured individual pays for health services, regardless of the actual cost of that service.

Co-insurance: A percentage of the cost of a health service, usually 20%, paid by the insured individual.

Deductible: An amount an insured individual must pay for health services before their insurance plan begins to pay any benefits. For example, the individual may be required to pay the first $500 before the insurance company will pay for subsequent services.

Formulary:A list established by a health plan or PBM to indicate which drugs they cover or which tier drugs are in.

Generic drug: A drug that is no longer patent protected, so that many companies can copy and manufacture the drug with the same active ingredient as the original inventor.

Mail Order: Prescriptions that are received in the mail.

Out-of-Pocket MaximumAn upper limit on how much an individual or family must pay in a year for health services. Once the limit is reached, co-insurance and sometimes co-payments do not have to be paid.

OTC Drugs: Over-the-counter (OTC) drugs can be purchased without a prescription and are generally not covered by insurance.

Pharmacy Benefit Manager (PBM): A company that administers a pharmacy benefit plan. They aren’t insurance companies; but are often subcontracted by health insurers or employers to manage the prescription drug portion of the health plan.

Prior authorization:A requirement that a physician obtains approval from the health plan or PBM in order to get the medicine covered.

Step therapy: A requirement of the health plan or PBM to try a less expensive drug first. If that drug fails to work on the patient, the health plan or PBM will then approve the use of a more expensive drug.

Therapeutic substitution: The process of switching an existing prescription to one that is less expensive and chemically different, but has the same expected clinical effect.

Tiered co-pay (co-payments)A co-payment that is determined by which tier the drug is assigned to by the health plan or PBM. There may be a few tiers, each with a different co-payment amount. This design is intended to encourage the use of drugs that are in the less expensive tiers.

Questions for choosing an Rx drug plan – National Consumers League

Before you decide on a prescription drug benefit plan, get the facts you need.

1. Will I be able to get the medicine that my doctor and I think is best for me?

Find out if the health plan or PBM has a limited list of medicines it will cover (known as a formulary). If someone in your family takes medication for a chronic illness, such as high blood pressure, asthma, or high cholesterol, make sure that medicine is on the formulary before you select that plan. If it isn’t, and you choose that plan, you will be expected to switch to a different medication or pay for it out-of-pocket. This is a discussion you should have with your doctor — to make sure you are taking the drug that is best for you.

Find out if the health plan has to pre-approve certain medicines before you can fill the prescription. Many plans require your doctor to get “prior authorization” of high cost medications before you can get coverage for them. That means your doctor or pharmacist must call the health plan or PBM for permission to give you a prescription for these medications. Some plans also require you to try a less expensive medicine first — before they will cover the one your doctor recommends. Check with your plan to understand their authorization process and restrictions to avoid a surprise when you get to the pharmacy. And be sure to learn how to appeal these requirements and decisions if you feel it is important.

Find out how often your health plan or PBM changes its formulary. Be aware that, in most states, even though your medications may be covered at the time you choose your health plan, the health plan or PBM may change its list of approved medicines at any time throughout the year. If they choose to take your medication off the formulary, you will be expected to pay out-of-pocket or switch to a medication the health plan prefers. Check to see what sort of notification you will get so you can discuss changes with your doctor.

2. How much will I have to pay for my prescriptions?

Find out about the co-payments. Most plans require you to pay a co-payment for each prescription. Some plans have just one co-pay amount, for example $10.00, for any prescription. But many plans have different levels of co-payments (known as tiered co-pays) for different medicines. If the plan you are considering has tiers, you should find out what medicines are in each tier and what the co-pay amount is for each. Note that the health plans and PBMs can move your medication from one tier to another at any time. If the amount you will have to pay is more than you can afford because your medication is in the highest tier, you may want to ask your doctor if there are other drugs on a lower tier that is appropriate for you. Also ask about how you will be notified if your plan makes tier changes.

Find out if there is a limit on how much you have to pay each year. Many health plans try to protect individuals from catastrophic costs by having “out-of-pocket limits.” You don’t have to pay co-insurance on medical services once you reach that limit. But prescription medications are often not included in the protection. So you may still have to pay your co-payments for medicines even after you reach the out-of-pocket limit.

Find out if the health plan offers or requires you to get your medicines through a mail order service. Some plans offer a mail order service for medicines and offer incentives like lower co-payments to encourage you to use it. Other plans have mandatory mail order services and require you to order your long-term medications through the mail. The plan will not pay for them if you get them at a local pharmacy.

3. Does the health plan allow me to appeal for coverage of prescriptions they have denied?

Find out about any exceptions or appeal processes offered by the health plan or PBM. If you really need a medication because of a valid medical reason, you can often get it covered. But you must go through whatever exception or appeal process the plan may have, and they have to agree that you really need the medication you want, based on information your doctor will be expected to provide. If you can’t wait for the process to finish, you may need to pay for the drug yourself and then file an appeal to be reimbursed by the plan later.

You should be aware that you will not be notified of your right to appeal when you are denied coverage because your medication isn’t on the formulary. So you must become familiar with how to file an appeal on your own initiative.

You should also know that most plans do not allow you to appeal for a lower co-pay level, even if the only medication that works for you is in the most expensive tier.

Get the answers!

The following resources can help you get answers to these questions:

  • Materials that the health plans or PBMs give you
  • The Web site for the health plan or PBM (look for general benefit information and plan requirements, as well as information on their current formulary)
  • A sales representative from the plan (they are often available at your worksite during the time of year when you must make decisions about your plan for the coming year)
  • The benefits department in your employer’s human resources division
  • The state Department of Insurance or, if your state has one, the Managed Care Ombudsman