Coumadin, colonoscopy 'n' pill sizes

[catwoman]

Am facing having a colonoscopy this summer. Have had one conversation with the gastroenterologist's office already. Talked with an RN from United Healthcare. Have a cardio appt. 4/1 (egads! Who wants to see a cardio on April Fool's Day, especially if he's a standup comedian?) and will talk to him then.

Today, during my annual physical, my PCP and I discussed the colonoscopy. I told him I don't want to be off Coumadin for 3 days for the colonoscopy, that I'm willing to go the Lovenox route. He said he agreed with me, that if he had a mechanical valve, that's what he would do. Said it's not nearly as crucial for others who take Coumadin, but with heart valve patients, it is.

BTW, he said I was doing very well at managing my Coumadin. I'm switching to generic, and he had no problem with that since I have a home test machine. Said yo-yoing between mfr's for generics can show some differences (my unspoken comment: was the patient being as consistent as possible?).

I did get him to write me new scrips for warfarin, 10s and 2s. I take 6mg X 7, and I told him it'd be cheaper to halve the 10s and 2s. Any of y'all do this?

 

[Guest]

If you pay for your own, it could be cheaper, but probably not if you have co-pays.

 

[Ross]

I slice em, dice em, fry em, eat em, whatever has to be done to make it work. In other words, yeap, I do the same.

 

[bvdr]

The doses I have on hand are 2.5, 3.0, and 4.0. With these 3 I can make up every dose I have been on.

Last time in the hospital I was on 10mg a day for several days but now I'm on 5.0mg. So far my insurance has paid for all my warfarin even when I have gotten two different doses filled at the same time.

When I had my colonoscopy I was on the lovenox too but the injection the night before was held and then the injection the morning of was held until after the procedure.

 

[catwoman]

Al:

Why might it not be cheaper with co-pays?

 

[Guest]

Because you pay a flat amount for each prescription.

If you buy 5 mg and adjust the dose by taking 1/2 tablets or 2 tablets then you pay 1 co pay $25.00 per month.

If you buy 3 mg, 4 mg and 5 mg and adjust by taking different pills per day then you pay $75.00 per month.

I know that by "fooling" the computer in the retail pharmacy you can get more than a 1 month supply for each co-pay. However, the insurance company may audit this. They probably won't for an inexpensive drug such as warfarin but it could happen.

 

[Sierra Bob]

My PCP prescribes one 4mg and one 5 mg per day at my request (I self test). With these, technically I can easily adjust from 56 to 70 mg per week to keep my INR between 3.0 and 4.0 where my cardiologist wants it. Realistically, I take two 5 mg twice per week and a 4 & 5 the other five days. With the 4 & 5 mg tabs it is possible to go from 4 mg to 15 mg per day by taking one to three tabs per day! Taking two 5 mg twice per week results in a deficit in 5's and a surplus in 4's, so occasionally I take 2 1/2 4's. Fortunately (for me) my mail-in pharmacy screwed up twice and refilled my presription for 4's after 60 days rather than 90 days as my plan prescribes, so I have plenty of 4's to "play" with. Also, three times in the past few months, I've reduced my INR to 2.0 to 2.5 due to oral surgery for my osteoradionecrosis. This also has resulted in a small surplus of tabs.

Al is right regarding price. I pay $15.00 per 90 tabs regardless if it's a 1 mg tab (which I took in the past, rather than two 5's) or a 4 or 5 mg tab.