Rising healthcare costs is a big concern in Singapore. With limited manpower, land and financial resources, Singapore faces a huge challenge of keeping prices of medications competitive yet affordable for the public. Thankfully, there are options you can advise patients on to minimize the costs of medications.

1. Perform medication reconciliation

Many pharmacies provide free medication review services in hospitals and community pharmacies. Medication review involves medication reconciliation, which can assist to streamline the use of medications. Drug related problems such as drug use without indication, therapeutic duplication, and non-adherence to medication regime can be flagged out to the prescriber during the process. The end point is for patients to enjoy a succinct list of medications catered to their needs. Discontinuing an unnecessary medication can help patients reduce their overall prescription drug costs too.

2. Use generics

According to a Straits Times report “Medication cost set to fall as generic drugs hit market”, published in 2012, SGH patients saved an estimate of $900,000 in 2011, due to the use of generic alendronate, gabapentin and clindamycin [1]. Since 50 drug patents had expired in 2012; including common medications such as clopidogrel and atorvastatin, patients can save a great deal of money by using generic medication. Pharmacists can educate patients on the benefits of using generic medications and debunk the myth that “brand-less” medications are inferior to their branded counterpart. Patients should also be taught to request for generics whenever possible from their prescriber if branded medications are not a necessity.

3. Safely split medications

Medications can be split safely to save cost. However, not all medications can be safely cut. Medications with hard outer coat, extended and prolonged release medications, capsules, and medications with small and uneven shape are not advisable to be split. Splitting pills can also be an issue as patients can potentially receive an uneven dose of the drug. This is especially dangerous for drugs with narrow therapeutic index, such that even a small crump of the medication bits make a big difference in dose. Also, for patients with poor vision and dextrality issues such as glaucoma and Parkinson’s disease, splitting pills can be a daunting task. Certain medications such as sodium valproate and bisacodyl are enteric coated and are not meant to be split due to its side effects when cut.

4. Fill longer duration for drugs with stable conditions

Patients with chronic but stable conditions that require the use of long-term medication can save money by filling longer duration of the prescription. This can help avoid cost incurred in making multiple trips to the pharmacy, spending a long time in the queue and having to pay for consultation fees with the doctor on each visit.

5. Capitalise on national subsidy for medications

In Singapore, patients enjoy drug subsidies based on their paying status and the scheme under which the drug is covered. Subsidy of medications depends on the classification of the medications within the national drug list, with standard 1 medication usually being the cheapest followed by standard 2 medications. The more expensive medications are the non-formulary and non-standard medications. Pharmacists can recommend the use of drugs in standard drug list over non-standard ones to capitalise on national subsidy for medications for Singaporeans and Permanent Residents.

Pharmacists are the gate keepers when it comes to curbing the unreasonable cost of medications. When in doubt about which ways to lower medication costs for patients, always remember these five tips. MIMS

[1] The Straits Times. Medication cost set to fall as generic drugs hit market. 28 June 2012.

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