# Prescriptions



## itfciain (Sep 1, 2014)

Hi All

Quick question - we need to get a prescription for my daughters eczema - my wife has a medical plan and we will be signed up as dependents at the end of the month. We went down to a health clinic yesterday and were told it was $136 to see the person to write a prescription (presume a Doctor?) - that sounds pretty expensive considering we know which creams she needs - is there any other way we can get a perception over here? 

Thanks
Iain


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## AmyD (Jan 12, 2013)

Nope. That's how it is done in the USA.


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## itfciain (Sep 1, 2014)

Succinct, but to the point !

Thanks - seems a lot but then again I think we're spoiled in the UK with the NHS


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## xabiaxica (Jun 23, 2009)

AmyD said:


> Nope. That's how it is done in the USA.


it's how it's done in most countries isn't it?

only a doctor can write a prescription

I suppose there's a chance that the cream is available over the counter - or at least something similar or equivalent - so it might be worth asking at a pharmacy?

istr that when we lived in the USA there were some things available OTC that were prescription only in the UK - & vice versa


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## itfciain (Sep 1, 2014)

It was more the $136 required to write the prescription I was questioning - but if that is what it is then I will just have to get it paid


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## 2fargone (Jun 14, 2011)

itfciain said:


> It was more the $136 required to write the prescription I was questioning - but if that is what it is then I will just have to get it paid


Go to a CVS or a Target. They have someone who can write RX and it is usually cheaper. 

Not a doctor but someone who is still able to write a RX.

A Physician Assistant and Nurse practitioners can write a RX in the USA.


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## twostep (Apr 3, 2008)

2fargone said:


> Go to a CVS or a Target. They have someone who can write RX and it is usually cheaper.
> 
> Not a doctor but someone who is still able to write a RX.


Can you please elaborate? I have never heard of this.


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## Crawford (Jan 23, 2011)

itfciain said:


> It was more the $136 required to write the prescription I was questioning - but if that is what it is then I will just have to get it paid


The doctor won't be just writing a prescription. He/she will usually take the history, do a quick exam and then, if satisfied that is what the person needs, will write the prescription.

When I go to see my primary doctor I first get met by the nurse who takes temperature, blood pressure etc and quick history. Then I see the doctor. It might be overkill for most visits, but that's usually how it is done and it all needs to be paid for. 

*Everything *has a cost in the medical business in the US. You have to get used to it.


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## twostep (Apr 3, 2008)

Check your area for a "doc in the box". Initial visits should be around $50. They go by ... Urgent care and such. Or ask for the pharmacist (not the pharm tech) at a local drug store who should know who they deal with frequently.


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## Crawford (Jan 23, 2011)

2fargone said:


> Go to a CVS or a Target. They have someone who can write RX and it is usually cheaper.
> 
> Not a doctor but someone who is still able to write a RX.
> 
> A Physician Assistant and Nurse practitioners can write a RX in the USA.


...... it might be cheaper to get a Physician Assistant or Nurse practitioner to write a RX but it won't be 'cheap'


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## Crawford (Jan 23, 2011)

Physician Assistants can prescribe drugs under the authority of a supervising physician:

Information Bulletin - Physician Assistant Board

There is not usually a physician in a CVS or Target, so sounds like you cannot get prescriptions written at these places?


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## Bevdeforges (Nov 16, 2007)

One other thing to understand is that even if you "know" what prescriptions are needed - they sometimes use different medications in different countries. Or some medications are or aren't approved/available. 

Most states I am familiar with in the US require a prescription be written by an in-state doctor in any event. And, there is no control over how much a doctor charges for a "simple" visit, particularly if you don't have one of the insurances the doctor is used to dealing with. 
Cheers,
Bev


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## Bellthorpe (Jun 23, 2013)

The job of a physician is not to 'just write a prescription 'cos I know what I need'. 

The job of a physician is to assess a condition with its symptoms, context, previous treatment and prognosis. And perhaps write a prescription. 

On subsequent visits to the same doctor, it might be easier to get a prescription renewed.


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## 2fargone (Jun 14, 2011)

twostep said:


> Can you please elaborate? I have never heard of this.


They are springing up all over the USA. These are great because the cost is laid out in front of you and no surprise when you get your bill! 

Here is the link.

Target : Clinic : guide to a great visit

come on in to a Target Clinic®

A nurse practitioner or physician assistant will see you in a private exam room.

Here is the CVS one: http://www.cvs.com/minuteclinic/services
MinuteClinic® walk-in medical clinics are staffed by nurse practitioners and physician assistants* who specialize in family health care. We care for children and adults, every day with no appointment needed.


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## 2fargone (Jun 14, 2011)

Crawford said:


> Physician Assistants can prescribe drugs under the authority of a supervising physician:
> 
> Information Bulletin - Physician Assistant Board
> 
> There is not usually a physician in a CVS or Target, so sounds like you cannot get prescriptions written at these places?


You can at a Target or CVS minute clinic.

come on in to a Target Clinic®

A nurse practitioner or physician assistant will see you in a private exam room.
You'll receive a treatment recommendation and, if right for your diagnosis, a prescription.
A personalized summary of your visit will be printed, and you'll have time to ask the provider questions.

Target : Clinic : guide to a great visit

MinuteClinic® walk-in medical clinics are staffed by nurse practitioners and physician assistants* who specialize in family health care. We care for children and adults, every day with no appointment needed.

Minute Clinic Services


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## twostep (Apr 3, 2008)

Thank you 2fargone


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## BBCWatcher (Dec 28, 2012)

Walgreens has also now gotten into this business. "Walgreens Healthcare Clinics" are available at many Walgreens locations in the U.S. The clinic doesn't have unlimited prescription writing ability, but it can write a 30 day prescription refill for most medications on a one-time basis.

Yes, this aspect of the U.S. medical system has changed fairly recently. It's why I keep saying that, if your last experience with the U.S. medical system predated 2014, you really don't know today's U.S. medical system. It has changed a lot and continues to change. The rise of the clinic-in-pharmacy services is another way U.S. healthcare has changed.

There are also a lot more public health centers thanks in part to the Patient Protection and Affordable Care Act ("Obamacare"). The public health centers are much more affordable (and usually free), and they can often dispense certain medications (including some popular prescription medications) on the spot without requiring a separate visit to a pharmacy.


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## koppazee (Mar 11, 2011)

Having gone the route of skin conditions, I do wonder about the amount of knowledge anyone outside of a doctor who specializes in dermatology might have. 

From my experiences, a dermatologist tends to stay on top of new meds, new treatment options and so on. Sadly, all this experience comes with a price tag. 

If the prescription is for a basic, run of the mill skin med, then by all means, a person should go the cheapest route as others have mentioned here but for other treatments that requires the most up to date knowledge, specialists come with a very large price tag! Warm regards.


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## BBCWatcher (Dec 28, 2012)

koppazee said:


> From my experiences, a dermatologist tends to stay on top of new meds, new treatment options and so on. Sadly, all this experience comes with a price tag.


Yes, a price the original poster has already paid. This is a prescription refill for a medication successfully treating eczema. Most of us most of the time are not fodder for medical journal articles, and most of us shouldn't be paying $136 just to get a refill prescription written -- with no assurance the person charging $136 even knows how to spell eczema, by the way.

There are, very roughly, 4 billion prescriptions written in the United States every year. Let's assume 3 billion of those are refills, which is roughly correct. _Excluding the cost of the drug itself_, at $136 per refill for a doctor's charge that'd be $408 billion just in doctor's charges just to refill prescriptions. Do you know what US$408 billion would buy? Well, that amount of money would pay for all medical spending in the United Kingdom. _Twice over_, approximately.

Look, I'm sure there are fabulous dermatologists, and I'm sure the American Medical Association will keep trying to argue that they should have a monopoly on writing prescriptions, even refill prescriptions for eczema medications. But it's just nonsense to argue that most people already seen by a dermatologist and already prescribed a medication successfully treating their eczema should spend $136 to see a dermatologist again for a mere prescription refill. If that's how we think medicine ought to be practiced routinely, then practically nobody will be able to afford medical care, and people really will get sick and die as a result of the waste and price rationing of care. The economics matter, too! And thank goodness there are many other options in the U.S. besides spending $136 to get an eczema prescription refill written.

You can _always_ think about ways to spend more money on medical care to get something "better." If a dermatologist's consultation is so important for a prescription refill for eczema, why not get a _second_ dermatologist's opinion for another $136? Or, better yet, consult with a more expensive dermatologist who might charge $300 for her consultation? If $136 is good, $436 is better, right?

Please, let's be reasonable. The original poster has a reasonable point, and I don't think he deserves a lecture about the merits of (another, expensive) consultation with a dermatologist.


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## Bevdeforges (Nov 16, 2007)

But, BBC, the issue may come down to what medications are or aren't available in the US vs. whatever the OP was prescribed back home. 

Simple example: I take a very common medication here for blood pressure. It's not horribly expensive and it seems to do the trick for me. It is not, however, available in the US. Not sure if it's a question of FDA approval or patent restrictions or marketing considerations or what. But it just plain isn't used and so isn't available. 

Doctors are not supposed to simply write scripts on request. They should be taking responsibility for making sure the medication is the "right" one and is appropriate for the particular patient. And when you change countries, that usually means going through the appropriate tests again and allowing the doctor to decide what is or isn't appropriate. (Just look at the rampant abuse of ritalin and other medications to see why that is.)

Granted, you can sometimes get a doctor to simply write a script for a "refill" pending your signing up with a doctor for proper monitoring of whatever condition it is that you have. Just don't be surprised if it's only for 30 days or so. Or, if it's for a generic or alternative medication, should your preferred choice not be available in the US for some reason.
Cheers,
Bev


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## koppazee (Mar 11, 2011)

BBCWatcher said:


> Yes, a price the original poster has already paid. This is a prescription refill for a medication successfully treating eczema. Most of us most of the time are not fodder for medical journal articles, and most of us shouldn't be paying $136 just to get a refill prescription written -- with no assurance the person charging $136 even knows how to spell eczema, by the way. There are, very roughly, 4 billion prescriptions written in the United States every year. Let's assume 3 billion of those are refills, which is roughly correct. Excluding the cost of the drug itself, at $136 per refill for a doctor's charge that'd be $408 billion just in doctor's charges just to refill prescriptions. Do you know what US$408 billion would buy? Well, that amount of money would pay for all medical spending in the United Kingdom. Twice over, approximately. Look, I'm sure there are fabulous dermatologists, and I'm sure the American Medical Association will keep trying to argue that they should have a monopoly on writing prescriptions, even refill prescriptions for eczema medications. But it's just nonsense to argue that most people already seen by a dermatologist and already prescribed a medication successfully treating their eczema should spend $136 to see a dermatologist again for a mere prescription refill. If that's how we think medicine ought to be practiced routinely, then practically nobody will be able to afford medical care, and people really will get sick and die as a result of the waste and price rationing of care. The economics matter, too! And thank goodness there are many other options in the U.S. besides spending $136 to get an eczema prescription refill written. You can always think about ways to spend more money on medical care to get something "better." If a dermatologist's consultation is so important for a prescription refill for eczema, why not get a second dermatologist's opinion for another $136? Or, better yet, consult with a more expensive dermatologist who might charge $300 for her consultation? If $136 is good, $436 is better, right? Please, let's be reasonable. The original poster has a reasonable point, and I don't think he deserves a lecture about the merits of (another, expensive) consultation with a dermatologist.


BBC, I really think that you took what I said out of context. I was not by any means supporting what doctors charge nor was I saying that a person should only see a doctor. My point was to say that a specialist might have more up to date knowledge of available medications to treat an issue. That was all I intended. No need for you to be defensive. 

Rather interestingly, I went to the dermatologist here about three months ago for a skin condition. He prescribed these drugs, all creams. One was an over the counter moisturizer. The moisturizer was applied as he suggested. Within hours of just one application, I began to itch like crazy. Within 24 hours, I was going wild! My entire body broke out from this stuff. A week later, still itching and finally got into see the dermatologist. He was in shock. He spent 45 minutes looking at my body, doing online research and so on. He got me in to see the allergist who took what I got of this cream from the pharmacy. The allergist needed my body to heal so she could conduct tests. Two weeks later (3 weeks post application), I returned to her office where they began to test. In the time between healing, the hospital contacted the manufacturer of this cream and was sent the products, and the liquified compounds that make up this product. The doctors also asked the hospitals compound pharmacy to make up the same exact components in the purest form. 

What impresses me about the French medical system is that they, the doctors really do their very best. No need to worry about malpractice here like the US. Then not only did they determine the allergic reactions but went out of their way to ensure that the product was safe and that the company just didn't want to recall a product that wasn't safe. 

The extent the French go to here is impressive here. I detest the American medical system. I lived with it over 50 years. It is all about money. Doctors, drug manufactures, lobbyists and so on. I am very much in agreement with you over costs back Stateside. If a person needs a refill, it really is dependent upon what that drug is. A type 2 diabetic will go for blood work every three months and have a prescription for medications with refills to last three months. What is sad is how you will find that the cost of drugs seem to be about the same no matter where you tend to go. All the best and warm regards!


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