I went to my pharmacy the other day. I had run out of a medication and was after a refill. I hardly ever go the pharmacy without having some problem or encountering some annoyance or exercise in hoop jumping. This trip was no exception.
I am also nearly out of my albuterol inhaler. Albuterol is a type of drug called a bronchial dilator. It’s used as a “rescue inhaler” in the treatment diseases such as asthma by providing relief when the airways are constricted. Albuterol, in one form or another, has been on the market for 45 years and is a pretty safe and widely prescribed drug. It’s available only with a prescription, even though it is safer for asthmatics than a former over the counter medication that as many as an estimated 15-20% of asthma patients used as their primary medication (Primatene Mist, which went off the market in 2011).
I didn’t come home with a new albuterol inhaler.
My prescription for the drug expired just a few days before I walked up to the pharmacy counter. There is no grace period. It isn’t available over the counter. It isn’t available with a unexpiring prescription. I will need to wait several days before my clinic can review a request and transmit a new prescription to the pharmacy. All these things should change.
First of all, a drug such as albuterol should be available over the counter. It’s safety and effectiveness have been proven over many years. An individual who has need for a rescue inhaler, sometimes just to breathe more easily other times to bring a threatening attack under control, should be able to walk into any pharmacy and get a new one at any time. There is no particular need to limit its availability, especially from those who routinely use the drug to control their asthma. These people generally know when they need it and when they do not, they’ve usually lived with the condition for years if not decades. There are more significant risks attached to a number of over the counter medications, and significant risks for some asthmatics in limiting its availability. (Luckily, I am not in that category, although I should probably use my inhaler more often than I do.) Albuterol should have been over the counter long ago.
If not making it over the counter, maintenance drugs that patients will take for years to come should be prescribed on an ongoing basis. Patients who depend on these drugs to maintain their health, and possibly even their life, should not be allowed to get caught without a supply of and access to those drugs. Unless there are reasons related to a drug being habit forming, limits on the number of refills and expiration dates should be removed for these drugs after an initial period of treatment. Following the instructions of their physicians for doses, frequency, and so on, patients should be able to simply refill as they have need of it when their supply runs low. Given the expense of pharmaceuticals, even with insurance, few people are going to keep taking a drug they are told they no longer need to take by their physician.
And as a third fall back option, pharmacists should be able to use professional judgement and authorize a refill for recently expired prescriptions of drugs whose use is typically ongoing, particularly for drugs such as albuterol and many common maintenance medications. The patient can go home with the drug they need for ongoing health and the pharmacy can follow-up with the physician in the following days so that a renewed prescription can be put on record or notification that usage is to end can be provided to both pharmacy and patient.
Any of these should enhance the ease and timeliness of ongoing medical treatment, reduce run around and problems patients experience (I can’t be the only person who can hardly visit a pharmacy without there being a problem or a hick-up in the system), and ultimately serve people and their health. That none of these options are the case, or even seem to be seriously under discussion, strikes me as an example of how medicine continues to hold on to its old and inappropriate paternalism, even while much of medicine (pharmacies notably excepted!) has also made significant strides away from that old, antiquated, and ultimately harmful attitude.