Concerns about medication availability and affordability as well as potential virus exposure from doctor’s office visits may be causing some people with these conditions to change how they are managing their health. Some may be skipping appointments, getting off track with their medication regimen due to new roles and responsibilities, and splitting pills. “While I understand these concerns, you still need to address your condition through proper medical management,” says David Cutler, MD, a family medicine physician at Providence Saint John’s Health Center in Santa Monica, California. “This is not the time to play around with medication dosing, [making] changes on your own, or to avoid healthcare settings out of fear of contracting the virus. This is when we need to work together the most to make sure your condition is being handled appropriately so your health isn’t at risk.” Insurance coverage, rather than effectiveness, has often been the major sticking point to more widespread telemedicine use in the past, Cutler says. Now that they’re being used with more frequency, and by those with a breadth of issues as well as chronic conditions, healthcare providers and patients are hoping that coverage remains in place going forward. Cutler says telemedicine “is a fantastic way to talk with patients and get consultations for issues that don’t require seeing them in person. Even for those facing chronic illness, there are many doctor appointments that can be done this way. For example, to have a conversation about side effects, or to discuss changing medications." It can be informative for a doctor to see you in your home setting, adds Eric Goldberg, MD, a clinical associate professor and a senior medical director at NYU Langone Health in New York City. “We can understand what your space is like, and how it could affect your health,” he says. “It’s the new house call.” Chances are good that your usual healthcare provider is set up to do telemedicine. If he or she doesn’t, ask about your options, even if that means consulting a different specialist. Start by calling your doctor and find out if they do telemedicine that is covered by your insurance plan. If they don’t, they may be able to connect you with a different specialist whose services are. If that fails, call the number on the back of your insurance card to see if there’s someone you can see via telemedicine. Your insurance plan may have a preferred telemedicine platform that you can take advantage of. Of course, to take advantage of telemedicine, you’ll need a camera (either a webcam or a smartphone). Alternatively, you may be able to handle some issues via a phone call with your usual doctor rather than a telehealth app, but keep in mind that because of medical privacy regulations, your doctor may also be limited with this strategy. Dr. Goldberg suggests prepping for a telemedicine appointment the same way you would for an in-person visit, such as by writing questions in advance and having medications handy for review. You may also want to check your blood pressure, heart rate, and weight before the visit if that’s relevant for your condition. Learn More About Using Telemedicine Annual exams are also still being done in person, says Kathleen Wyne, MD, PhD, an endocrinologist at the Ohio State University Wexner Medical Center in Columbus, Ohio. For people with type 2 diabetes, for example, an annual exam involves labs, a thyroid exam, and a foot exam. She also advises that patients come in if they have new symptoms, such as neck swelling, unexplained weight loss, rapid heart rate, or uncontrolled hyperglycemia that hasn’t improved after a telehealth consultation. Dermatology appointments for annual skin checks, to help prevent skin cancer, are also still being done in person, among other in-office visits. When you make an appointment, you’ll be told how to prepare, adds Douglas Ambler, MD, an internal medicine physician at Northwestern Medicine Central DuPage Hospital in Wheaton, Illinois. For example, his office advises patients to begin wearing a mask as soon as they leave their cars. They may be asked to change from a homemade mask to a surgical mask upon arrival as well. No matter what your chronic condition, any doctor’s office will screen you for COVID-19 symptoms over the phone before you come in. If you’re experiencing any, and you still need to go into the office, you’ll be advised about the best procedure, Cutler says. That may involve going to a different entrance and being seen by healthcare professionals wearing extra personal protective equipment. But it’s important to keep up with your meds as directed, even while you’re dealing with this new way of life. “Staying on top of your medications is one of the best ways to lower the risk that you’ll need to go in to see your doctor or visit an emergency room,” says Dr. Ambler. “Consider it a big part of keeping yourself safe.”
Use Apps to Remember to Take Your Meds
To help you stay on track, there are plenty of apps and tech tools available. One option is Medisafe, a free top-rated app on the App Store and Google Play. Consider asking your healthcare team for recommendations specific to your health condition.
Find Online Support to Maintain Motivation
Furthermore, there are a bevy of online support groups at your disposal that can help you stay motivated to stay the course. If you have diabetes, for instance, the American Diabetes Association has an online support community to encourage peer connection during difficult times. Likewise, for those with fibromyalgia, resources such as the National Fibromyalgia and Chronic Pain Association provides access to a free online support community that can connect you with other people who may be facing similar treatment hurdles. These are just a couple of examples; ask your healthcare team which resources they recommend for your specific health condition.
Ensure You Have Enough Meds on Hand
Remembering and feeling motivated to take your meds is critical, but so is having the right amount stockpiled. The amount you should have on hand is related to your situation and condition, Cutler says. For example, if you’re immunocompromised, elderly, and relying on mailed prescriptions, you’d benefit from a 90-day supply, he suggests. But if you’re in a lower-risk group or have a reliable mail-order prescription system already set up, a 30-day supply is likely more appropriate. In addition to telemedicine, an issue that has usually been linked to insurance coverage is medication refills, says David Cohn, MD, the chief medical officer and director of gynecologic cancer research at the Ohio State University Comprehensive Cancer Center in Columbus. Those with chronic conditions who have ongoing medication needs usually have a certain timeframe before their insurance will cover a refill — such as 30 days — but Dr. Cohn says COVID-19’s sudden surge initially caused concern about whether insurance would allow patients to stock up for longer, like 90 days. Also, many patients and their families worried about availability, Cohn adds, because it was uncertain whether there would be supply chain disruptions. Fortunately, these worries turned out to be unfounded, but they did prompt some people to take actions that may have been against their best interests. “People began to wonder if they needed to conserve their medication,” he says. “For example, someone who has high blood pressure and takes medication daily for that might think, ‘Well, what if I skipped a day? Would that be so bad?’ And because they don’t see an immediate impact from that, they might try it. Others might think about conserving their meds by changing the dosage, such as cutting their pills and taking half the dose.” Even if you don’t see bad effects from strategies like that, it’s an unwise maneuver to play around with your medications that way, Cohn says. “You don’t know how this will affect you going forward, and you could be putting yourself at considerable risk by not managing your chronic condition,” he says. Whether you’re considering splitting pills because of concerns about medication availability or affordability, here are some things to reconsider:
Reduced duration Many once-a-day pills have a time-release coating, and when you cut the tablet, you’re changing that into an immediate-release tablet, says Ambler. That means the medication won’t last all day, as it should. In the case of a blood pressure tablet, for example, you could see your blood pressure rise later in the day because your medication won’t be in your system. With pain medication, you may have a shorter window of relief, meaning you’ll be in more pain later than you would have been otherwise.Dangerous side effects Some medications have what’s called a “very narrow therapeutic index.” That means if the pill is not split evenly, it could be dangerous, says Dr. Wyne, because you have a different dose on one day versus the next. That adds too much variability between days in your dosage, she says.Lower efficacy Medications will simply be less effective, adds Goldberg. Whether you’re trying to control pain, reduce inflammation, manage blood pressure, or reduce flare-ups in a condition like MS, RA, or a skin condition such as psoriasis, eczema, or rosacea, the medications you’re taking won’t be doing the job. That results in unpredictable effects, Goldberg says.
Yet there are now many programs available to help with medication costs, he says. Even if you can afford medications now but worry about whether that will always be the case, talk with your healthcare provider. There may be a program that can cover all or part of the cost, or you may be able to switch to a less-expensive but equally effective alternative. One option mentioned by Wyne is GoodRx, a website that lets you check medication prices at different pharmacies, and offers some discount coupons on select medications. Other strategies Wyne suggests are:
Call your insurance company. Ask them about their preferred medication for your condition, and ask about any rules in terms of refills or dosage.Do your research and consult a pharmacist. Look up medication costs and talk to your pharmacist about whether you might save money ordering a larger dose. If that’s the case, ask your physician if that’s an acceptable tactic. For example, since some pills can be safely split, you may be able to order a larger dose for less money and cut the pills. But definitely make sure your healthcare provider is on board with this plan before you try it.Fill your meds on schedule. Some insurance companies penalize pharmacies if prescriptions are filled within a certain timeframe, which may lead your pharmacy to cancel a prescription if you go too long without filling it.
Having a chronic condition is tough enough without throwing a pandemic on top of it, along with financial concerns and virus exposure worries. Fortunately, you don’t have to go it alone. Your healthcare team is called that for a reason. “We truly are here to help people with whatever they’re facing,” says Cutler. “Give us a call and talk to us. We have so many resources available, from financial experts to social workers to specialists. We’ll all get through this together.”
