Prescriptions for meters and supplies? Really?

[Protimenow]

Agreed. That's why I still think it's important that the warfarin be available by prescription only. The practitioner who prescribes the medication would then have the burden of checking to see that the person doing the testing knows what he or she is doing (but, for that matter, the practitioner should be reviewing the patient's values anyway). Of course, the warfarin can be bought from overseas sources and the patient could, conceivably, make major dosing errors. The overseas route makes little sense if the person getting the warfarin has a doctor or can get a prescription (because generic may be even less expensive here, when shipping costs are factored in).

Yes, it's possible that a person can buy a meter at the Acme Tester Store and mismanage the warfarin, but I suspect that if a person was so motivated, he or she would probably be diligent (and intelligent) enough to run the tests. (We should still keep in mind that: a) few of the people buying the meters and supplies are probably doing the testing without reporting to a medical practitioner or anticoagulation specialist and b) that anyone doing his or her own testing will probably be careful because the dosing and testing issues are literally putting their lives into their own hands).

In an earlier post, a person said that you can commit suicide by overdosing on warfarin. It's possible, but not particularly easy, to take a large enough dose for massive internal bleeding -- it may be easier to kill yourself just by stopping taking coumadin and waiting for a clot -- and THIS form of suicide requires NO prescription.

 

[yotphix]

I too don't agree that you should require an Rx for the supplies and tester, but then maybe the reason being is to ensure that the user follows the advice of their MD.

It may be worth mentioning that most of us tried following the advice of our MDs and found that somewhat wanting. This is a part of the reason many of us have turned to monitoring and regulating our own ACT.
I know that prior to the purchase of my monitor, and just 6 weeks after starting my anticoagulation therapy I had begun to alter my doses from the Doctor's prescription, and that was what got me stable and in range. I've not had an out of range test since then. An anti-coagulation clinic I tried at around that same time told me that they thought they were doing well if a patient was in range 50% of the time. So who should control my access to the various warfarin tablet sizes?
Any argument that it could be misused is I don't buy. What can't be? It would be easier and quicker to drown yourself in a bucket than to kill yourself with warfarin. It has no associated 'high' or other effect that could lead to it's misuse. It is possible that hypochondriacs who fear DVT or some such thing would take it unnecessarily and potentially harm themselves but how likely is that?
I see that the consensus here is that it ought to be a prescription drug. Frankly I wouldn't care if it weren't for the fact that I pay for a doctor's visit out of pocket while I am in the US! When I am home in Canada it is an extra trip to the Doc, and extra burden on the system but it affects me less.

 

[Protimenow]

Yotphix - you made some good points about making warfarin a non-prescription drug. After all, you CAN get it, if you really want it, by ordering it over the Internet. And it IS rather difficult to kill yourself with the drug.

However - you mentioned deep vein thrombosis (DVT), and scared me. If a hypochondriac fears (or maybe even actually HAS) DVT, and can get warfarin without a prescription, this kind of user actually COULD cause major personal injury. Chronically taking high doses, day after day, to treat a supposed DVT condition COULD probably kill that person. It's kind of scary.

I don't think warfarin is one of those drugs that would be common enough to earn a place on a pharmacy shelves next to, say, Excedrin and Tylenol (especially because there are so many strengths, and the manufacturers wouldn't want to make it available in just one or two dosages). If it's not as common as the basic OTC stuff, it's safe to assume that it'll be kept behind the pharmacy counter where a person buying it would probably have to ask for it - prescription or not.

I don't know how frequently hypochondriacs with unrestricted access to warfarin would actually do personal harm, but how many lives would have to be lost before the FDA will again impose restrictions on its distribution in the interest of public safety?

 

[yotphix]

On further reflection, I suppose that it is fairly easy to do damage to yourself with warfarin, compared with something like cough syrup or aspirin. Just a few pills could have you in serious trouble, where non-prescription meds would take a ridiculous amount to harm you. Better that it stays where it is.

 

[Davidr]

Oddly enough, here in Hong Kong, you simply walk into Roche Diagnostics and ask for a kit...pay your cash and you're set!

In fact, the times vie been short of meeds, I simply go into my local pharmacy with my old blister pack of warfarin and ask for a refill...no questions asked...

I sometimes wonder what would happen if I asked for a narcotic.

I know we sometimes want thing a little easier, but methinks that this goes a bit far!

 

[Protimenow]

I'm curious about how much, in U.S. dollars, an XS kit costs in Hong Kong.

It seems to me that in some areas (like protection of public health), imposition of certain restrictions or regulations IS in the public interest. I'm still personally committed to making the INR test meters and supplies available without prescription. (I'm not diabetic, thank God, but I can buy a blood glucose meter and strips at any pharmacy. Let the Insulin be available only by prescription - so I don't have to tools to easily kill myself). Same thing with warfarin -- let me buy the meter and supplies, but control access to warfarin.

 

[Davidr]

coaguChek XS Kit (Machines and 20 lancets) - HK$5800
24 strip tests PLUS Code chip - $1080
2x24 strips PLUS one Code Chip - $1728
Lancets (50) - $53

US$1=HK$7.75

Therefore:
Kit : US$748
24 strips: US$139.28
48 strips: US$222.85
Lancets: US$6.84

Roche will deliver anywhere in Hong Kong for all purchases > HK$300

Hong Kong has no sales tax or other hidden costs

This is an outright purchase, not a rental. I remember the sales rep mentioning something about a 2 year warranty...might be wrong about that.

Hope this helps

David

 

[Davidr]

Oh, another comment,

I agree with a prescription if you are going to claim the cost from a medical insurance, but the kits should be generally available.

In HK, while I did say that prescriptions are not generally needed (you can go and get most meds at most pharmacies), they are legally required, it's just that there is no record of prescriptions by doctor, or anything like that. The few times i have had a prescription, the pharmacist has looked at it, filled it, and returned the prescription with my meeds, without making any record of who I am, who the doctor was, etc.

 

[Protimenow]

Thanks for the price info.

Interesting about the policy for dealing with prescriptions. It makes sense that you'd be able to take an empty pill box or bottle and get a refill - the pharmacist would just ASSUME that someone gave you a prescription at some time.

 

[lance]

Hi David
Here in Ontario the XS costs $500 much less than the US. The US prices quoted on strips are much lower than here and the lancets are somewhat lower in price. Both my "S" and "XS" came with a 2-year warranty. My XS has lasted a lot longer than my old "S" and both of us use it so I think it's a much, much better monitor in every way.
Sandra

 

[Protimenow]

That seems to be the general consensus. I'm hoping that Roche decides that they can give me a good deal to upgrade my S to an XS.

I'm curious (and will start a different thread) about how the InRatio and InRatio 2 compare to the XS.

(But, as I said, I'll start a new thread on this topic)