Reasons for being prescribed Lo Loestrin FE

[abalone99.livejournal.com]

I'm fighting my urge to get really upset and angry at the medical community and America's health system right now. I have a somewhat unreasonable (to me) fear and mistrust of doctors and I wanted to see if you lovely superstars could offer some possible insights into why my doctor might have prescribed me something before I questions my doctor's motives. The story:

I went to the OBGYN for the first time in about 5 years (see above paragraph re: fear of doctors for more info), was found to be in excellent health, tested negative for STD's, and pretty much told her my sole reason for wanting to visit was because I wanted to be put on a birth control that I could use to skip my periods and that would improve my skin a bit. I am also a smoker (about 3 a day on average) which I told her. She told me a) ALL hormonal birth control improves your skin (or has the potential to do so) and that the "improves your skin" claim was mostly a marketing scam. She also said she was going to have me try and gave me a free 3 month sample all nicely packaged in a little carrying case of Lo Loestrin FE and said to call back for a prescription if I liked it and had no problems. She said I can simply skip and throw away the non-active pills at the pills and begin my new pack. When I asked what the deal was with the brown vs. white pills she explained that the brown pills had iron in them. I asked if there was any danger in taking the brown bills just for some extra iron and she said, sure, why not. This is important to note because she apparently didn't want me to try this medication BECAUSE of the iron as she a) didn't explain that iron existed in the meds in the first place and b) seemed to not care one way or another if I took the iron pills or not. This brings me to yesterday when (after the doc and pharmacy offices bungled sending in my prescription) I go to pick up the prescription that was called in and the pharmacy only gives me one pack. There was some confusion about why I was only getting one pack and finally after a lot of talking and a lot of supervising it looks like they only had one and were expecting more to arrive. I wanted to know how much my copay was going to be for all this before I took it away and starting using it knowing it was for a 'name brand' drug for which there was no generic (the doctor having previously told me this). There was much debate (for a while they told me there was *no way* they could find out) and FINALLY I was able to find out that my COPAY for THREE MONTHS worth of birth control was going to be $150. I have excellent health insurance with relative low copays, VP, and I just about fainted. This is not doable for me. So I took the one month supply (because my insanely painful periods are about to return) for $50 and asked the pharmacist if there was a generic and where to go from here. Again, after much nerve-wracking confusion about how to get my prescription changed the pharmacist told me that there was a generic form of the SAME EXACT BC just without the iron pills. Now, VP, I am starting to get a little furious. WHY would my doctor prescribe/suggest a name brand BC over all the other generic types just because (as far as I and my, admittedly non-too 'with it,' pharmacist can tell) it has some iron pills in it that my doc didn't even seem to care if I took in the first place.

I'm a little upset that my doc my have prescribed me something just because some pharmaceutical company was pushing their drug. I know this happens in America, not sure if it's allowed in other countries, but I want to find out, before I overreact if there's ANY reason someone can think of that I'd be prescribed this particular expensive name brand drug before I question my doctor's motives. TIA, wonderful VP-ers.

Comments

[fuckering.livejournal.com]

Are you in the US? That's exactly why the prescribe certain pills. They get paid to. Though, most pharmacies will provide generic when asked. Some do it automatically (if your pharmacist loves you).


I wish there were such a thing as generic insulin... because let's not even start to talk about how much my meds cost. It's ridiculous. I have awesome insurance, but the copays are obsceeene. :(


Sorry. Your post obviously hit a nerve. <3

[archangelbeth]

Most US insurances require pharmacies to provide the generic (they won't pay anything for the brand name if a generic exists!), or the pharmacies do it anyway unless there's a "dispense as written" on the prescription. For some drugs, this is inconvenient-to-bad. I took my generic levothyroxine back to the pharmacy and griped! (Every time you change brands -- even generic "brands" -- of levothyroxine, it requires another round of blood tests to see how it's being absorbed and what your levels are doing. When I'm stable on one dose, I don't want more needles!)

[paperdolls-tear.livejournal.com]

This is true, that by law pharmacies must dispense the generic form unless otherwthise specified by the prescriber or patient (they are billed differently). Synthroid/Levoxyl (brands for levothyroxine) happen to be one of the most brand medically necessary drugs!

[archangelbeth]

Unithroid, for me! O:> Mind, the brand name is very cheap -- it was down to $11 for 30 pills (88mcg dose) when my insurance started covering it again. I think it stopped covering it around $13 for a bottle.

My co-pay is $10 or a fraction of the cost, whichever is less. *beth rolls her eyes*

[paperdolls-tear.livejournal.com]

What country are u in?

Same name btw!

[archangelbeth]

USA here. I'm not sure if it's a state law to do the generics or not -- may depend on the state, if you're on state Medicaid or private insurance, etc. I do know that many insurances require -- as in, will only pay for -- generics, if generics exist. (Which is why I started paying for Unithroid out of my own pocket.)

[nightmer.livejournal.com]

And insulin is exempt from ever going into generic versions, so we get to pay full price forever! Hurrah, pharmaceutical industry.

[draiochta-faol.livejournal.com]

It sounds like she said you could stack your pills to skip having your period (or on HBC it would be a withdrawal bleed). There is no harm in taking the iron pills, as these are the non hormonal pills that would signal a bleed. The iron in them helps because some people get anemic when they bleed.

Also, she probably gave you the Lo Loestrin FE because it's what she had on hand in her office. It's a newer HBC and it has a lower dose of estrogen (I believe). Yes you can get Lo Loestrin without the iron, but like I said, it's probably just what she had on hand.

[nickelshoe.livejournal.com]

Sometimes doctors are not well-informed about how much the drugs cost. You might be able to get a prescription for the non-iron version by calling her office and explaining.

[kitsu.livejournal.com]

Seconding this. I was prescribed Loesterin FE the same way (3 month supply and the pretty pouch). With my insurance at the time the co-pay was $45 for a three month supply. Then my insurance changed and it became $45 for ONE month. I called the doctor and got it changed to a generic that was $30 for a three month supply.

Hopefully your doctor can do something similar. Good luck!

[elialshadowpine.livejournal.com]

This. My psych, when I told her I didn't have insurance, actually sent me home with a list of medications to check into the pricing for because she had no idea and didn't want to end up prescribing something that would be unaffordable. Which is a lot better than most doctors, who really have no idea, and just go prescribing whatever.

[archangelbeth]

Basically, doctors offices can't tell what insurance is or is not going to pay, and the pharmaceutical companies hand out free stuff all the time (in pretty little carrying cases, no less!) exactly to get people "hooked" on the brand name stuff. (And sometimes insurance is iffy about what it covers. I've paid $10 for generic Valacylovir (Valtrex) and I've paid $40. Well, the spouse paid $40, which is what the brand name version costs; if I'd been picking it up, I'd have gone, EXCUSE ME, IT WAS TEN BUCKS LAST TIME!)

So I wouldn't totally hold this against the doctor, but I would inform her that your insurance is talking about a $50 payment per month, and ask to be prescribed the generic without-the-iron-in-the-placebos. (And while I wouldn't say this is an automatic red flag about the doctor, it may be a yellow one; she's clearly not really well-informed about what insurance is or is not likely to cover, and is seemingly going, "Oh, well, we have this lying around because the marketing dude came by with it, so let's try this. Looks reasonable.")

[fallenfaun.livejournal.com]

Even with one insurance company you can have two totally different plans so it's a bit much to expect a doctor to know how much everything costs outside of a hospital (where you can call the pharmacy and go "hey what do we charge?"). My pharmacy can't even tell me how much things cost until after they bill my insurance so idk how my doctors would know.

[archangelbeth]

I don't think it's out of bounds to expect doctors to listen to what their patients say, and think about insurance issues -- knowing that a new formulation won't have generics, and is probably going to be more expensive under many/most insurance plans, is something that I would expect a doctor to think about!

But if that's the only flaw that a doctor has, it's just something I'd remind them about when they're prescribing stuff.

If it's one little issue of many, then I think it'd count towards a total of, "You know, this doctor requires constant micromanaging. I think it's time for a new one."

[fallenfaun.livejournal.com]

I guess it's a bit touchy for me because I have so many people insist on having name brand medicine and then come back to throw a fit because the doctors wrote "no generics" and the pharmacy is charging them $200. It's sort of a double standard because you wouldn't yell at a store clerk for telling you that a designer bag costs $700 but ime it's somehow more acceptable to be rude about the cost of healthcare than it is when paying your other bills.

I don't think it's unreasonable to ask for a generic because of cost but I do think it's important to actually ask about them if the doctor has a habit of just writing in the name brand.

[archangelbeth]

I think the rudeness is likely derived from helplessness. We can get cheaper purses, but we need our drugs -- and there's so many mixed messages about generics, and even mixed results to fuel those mixed messages. E.g., I'm happy with the generic for Valtrex, and it seems to work just as well; meanwhile, I insist on the brand name of Unithroid (levothyroxine).

(And then, of course, there are people who would yell at a store clerk for a high-priced purse! *sigh*)

Just one of those things to monitor a doctor's habits on!

[princessselene.livejournal.com]

This, plus if it's an SSRI, my insurance wouldn't cover Lexapro (no generic yet...my old insurance switched me without warning a couple of years ago to Celexa. Escitralapram v. citralopram...NOT the same thing) That didn't work too well. Then they tried Zoloft (that made me sleep 20 hours a day). Only now will my insurance cover Lexapro so it's $30/mo. instead of $135 out of pocket per month.

The current insurance I have now (that took my doctor's word for it that I failed the two prior SSRIs) likes to cover generics rather than brand name. To my knowledge, most insurance companies will cover generics more readily than brand name. The Sprintec I was on a couple of years ago was never more than $30 for a 3 month supply.

[shyshutterbug.livejournal.com]

Actually, I beg to differ with your pharmacist. There is actually no generic available (http://women.emedtv.com/lo-loestrin-fe/generic-lo-loestrin-fe.html) for LoLoestrin at this time. It's a very new pill, having premiered this summer, I think; generics won't be available until the drug goes off-patent - per that link above, that's in 2014. There are comparable pills with generics available - regular Loestrin 1/20 or 1.5/30, for example, have the same estrogens and progestins that LoLoestrin has and have generic equivalents - but both have more estrogen (20mcg and 30mcg, respectively) compared to LoLoestrin's 10mcg. (There's not even another 10mcg pill on the market at all, regardless of the progestin.) I'm...actually pretty dismayed that a pharmacist wouldn't pick up on that big difference.

The likely reason she picked this pill for you? From a prescribing standpoint, a lower estrogen dosage makes a lot of sense for a smoker (regardless of amount) - so I'd pick that as the number one reason she'd go for that pill over another - the less estrogen going into your body, the less risk of venothrombolic events (DVT/pulmonary emboli) you have. The drug reps do mention that to the docs. Obviously I'm not going to say that "yay new pill!" didn't play some role in her decision, but samples of various pills frequently collect dust on our shelves if our docs aren't excited about them for reasons other than patient care.

That said, $150 is ridiculous (been there), so I'd tell her thanks but no thanks on that particular pill and see if she has any other ideas. Or ask for her to hook you up with as many samples as they can spare; I dunno about that office's Warner-Chilcott rep, but ours loads us down with LoLo.

[paraxeni.livejournal.com]

This isn't the first time I've seen reports of pharmacists mixing up LoLo fe and plain Lo fe. I'm sure I've even seen a post here about it.

The US system is a bit baffling to me. In the UK you get your prescription, take it to the pharmacy, and get 3 or 6 months supply. When the next boxes are due the GP practice releases the next prescription to the pharmacy, and you go and get the pills, or have them delivered. There are no six or twelve month check ups, you just keep getting them as long as you want them. I think my pill has been issued on the same prescription now for six years. I wish people in the US could benefit from a system like ours.

[shyshutterbug.livejournal.com]

Unfortunately, me neither. My doctor has taken to having me write out the prescriptions instead of her, because I have very sharp, neat print by comparison to her handwriting. It's disturbing, however, that a pharmacist wouldn't, y'know, look a little closer at that.

And trust me, I wish we could benefit from your system too, because this is ludicrous. The OP is not the first person I've heard of who's had issues with paying for LoLo. Until this cycle, I was on a birth control pill with two available generics. My doc originally phoned in one of the two generics - copay = $60 for one month. Oh hell no. I called her; she said, "hmm, let's try this." She phoned in the second generic - ten bucks. Seriously. I do not understand.

[paperdolls-tear.livejournal.com]

Office staff write out prescriptions all of the time- theres nothing wrong with that. Aside, the copays/what's not covered is all determined by insurance companies which happen to SUCK. Whether the MD is promoting a pill or just prescribing what you want there is NO way for the MD to know what your insurance will cover at the pharmacy bc insurances vary greatly.

[shyshutterbug.livejournal.com]

Yep, this. While there are trends in what might be going for a higher or a lower copay, individual policies are different, companies are different, and if you're uninsured, pharmacies charge differently. If a doc gets unduly excited about a new pill, they're probably just...unduly excited about a new pill. They're not getting anything out of it, really.

It's only really notable that I write out her LoLo scripts now because we've had SO much trouble with people getting the wrong Rx that it's just prudent for me to block letter it now - she writes all her own scripts otherwise. (I've offered - she says she's good. I positively adore her, but it's a little strange, because she's the most independent provider I've ever worked with.)

[frolicnaked.livejournal.com]

She phoned in the second generic - ten bucks. Seriously. I do not understand.

I've mentioned this elsewhere on VP (sorry for those for whom it's a repeat), but I switched insurances this fall while keeping the same scrip for BC. After some initial confusion, the pharmacy tried to fill it with the standard generic; it ran through the system as requiring me to pay full cash price ($35.99/pack, in this case). The pharmacist ran through the name brand ($57.99/month at this store): ten bucks.

[sharpenedyaks.livejournal.com]

Yeah, my insurance covers name brand Orthocyclen as a generic for $5. "Generic" versions count as Tier 3 drugs and cost me $40.

[frolicnaked.livejournal.com]

Agreed with all of this.

[jennifer0246.livejournal.com]

yep, this.

[neumeindil.livejournal.com]

More than likely a drug rep stops by her office every few weeks with samples and/or coupons so she'll prescribe/give patients the thing they can get more cheaply that day. Doctors know prescriptions are steep for pretty much everyone, and it's a way they can help defray costs. But then when the samples don't come in when you need them, you get hit with a huge copay because insurances aren't mandated to cover anything they don't want to.

If you explain this to the doctor, she'll likely write you a Rx for the generic sans iron, but from my experience as a pharmacy tech, make sure she indicates that you're to be stacking pills when she writes the prescription. Many times we had patients at the counter ask why they were only getting 1 pack to have to show them on the prescription that it was written with standard directions (1qdx30d) or simply "take as directed" with no indication to the pharmacy staff how she was "directed" to take it. You're right that the prescription drug situation in the U.S. is a mess, though, so good on you for digging into it and making sure you don't fall through the cracks.

[slice254.livejournal.com]

Yeah, what everyone else said about docs not really having any idea how much prescriptions cost is pretty accurate. My endocrinologist stays really informed (mostly because she advocates for her patients with insurance companies and pharmacies - she tends to prescribe non-traditional meds and non-traditional doses because she pays attention to what her patients tell her about how they feel - go figure!), but my dermatologist is really a little clueless, as is my primary.

And she probably thought she was doing you a favor by giving you a three-month free sample. With things like HBC, different people react differently to different meds. She thought she was saving you the cost of the prescription during that "try out" period.

Do call the office, though, and let them know how much your copay ended up being, and ask them to call in a prescription for the generic.

[nightmer.livejournal.com]

She might have just been uninformed. Also, I believe that Loestrin is more likely to reduce bleeding (or stop it completely) than many pills even if you take the blanks, so perhaps she'd heard something to that effect and associated it with your problems. Can your pharmacist tell you what pills will be cheap on your insurance? I've had good luck with just calling my doctors and saying "I want X pill, please send a prescription over" since doctors often don't seem to know particular reasons to prescribe one over another. While doctors are pressured to prescribe certain brands (which might have been happening), they really won't know what a copay will cost you as it varies plan by plan and I doubt she knew what a kick in the wallet it would be (Loestrin costs the same as every other pill I've tried on my insurance).

[zebra1987.livejournal.com]

As Shyshutterbug said, there is currently no generic equivalent to Lo Loestren FE. I was originally prescribed it as well. The closest match are the generics for Loestren 1/20, Junel 1/20 and Microgestin 1/20. I actually believe there is a third one but can't recall the name. I got switched over to those because I couldn't afford the cost of the name brand. I think I reneger seeing on their website that there is a discount card you can ask your doctor for that will limit your price to something like $24/pack. Maybe you can look into that?

[zebra1987.livejournal.com]

I mean I think I remember seeing! Argh, typing on my phone.

[paperdolls-tear.livejournal.com]

Okay...
So there is definitely no generic for your birth control at this time =[ There are however similar pills that do come generically. Loestrin & Loestrin FE(with iron) have generics available. There is also Loestrin 24 FE which only comes as brand but has a CoPay savings card out there for $24/month. The difference is the amount of ethinyl estradiol, 20mcg instead of 10mcg. It is common for MDs to prescribe based upon what new pill samples theyre stocked with but don't totally discount your doctor who may have had more reason. First of all as a smoker the lower estradiol would make her choice safer when it comes to clotting risk. Also, for someone first starting a pill, it wouldn't be suprising for her to start you on a low dose hormone. I would discuss switching to the 20mcg if your copays are too high. Currently for Lo Loestrin there is only a $10 savings card & $40 a month is still pretty steep. If you are stacking the pills, be sure your doctor writes it in the RX or you will come into problems with refilling too soon. Sorry this is jumbled & all over the place- it is late and I wanted to comment. Anyway, I work in pharmacy so if you have any questions you can ask!

[helpme11111.livejournal.com]

There is no generic for lo loestrin FE—maybe it's so new that the pharmacists were confused?

I've been told off for telling this story, but watch out for the EXTREME low dose of estrogen in that pill—it gave me what felt like the worst yeast infection mixed with bv for about 2 months before the effects wore off (i went off the pill after 3 weeks), and my doctor said the dose was so low my body was mimicking menopausal symptoms.

Could work for you! (if it was cheaper...)