Ask the Doctor - How can I save money on my prescriptions?

Ask the Doctor
Leslee B. Cochrane, MD.
Medical Director
Ramona Visiting Nurse Association and Hospice

Question: I spend over $300 per month on prescriptions and I don’t know how much longer I can afford them. Is there anything I can do to save money on my prescriptions?

Despite all the talk about how expensive health care is and how we need to reform it; there are several things you can do right now to save money that don’t require an act of Congress. Here are a couple of ideas to get you started on your own personal “ economic stimulus” plan:

1. An ounce of prevention is worth a $100 of cure – See your doctor and dentist regularly for check ups. A cavity costs about $100 to repair; if neglected the root canal and crown will run you close to $2,000. Likewise, with early detection diabetes and hypertension can be controlled thus preventing expensive complications such as strokes, heart attacks, and renal failure.
2. Too many cooks (or pills) spoil the soup- Many patients take more medications than necessary. Unnecessary medications increase cost and multiply the risk of adverse reactions. The next time you see your doctor, take your medications with you and ask the doctor these three questions: What is this for? What are the side effects? And, do I really need to take this? Stop all unnecessary medications. For more information see my article on Polypharmacy at www.ramonavna.org under the community news section.
3. The buck stops here- Once you have eliminated unnecessary medications as described above you should ask your doctor or pharmacist if there is a generic or less expensive alternative available. Wal-Mart has over 300 prescription drugs and over 1,000 over the counter medications available for $4.00 per month. Call your pharmacist or check out http://www.walmart.com/4prescriptions for prices.
4. A penny saved is a penny earned- If you can use a pill cutter, chances are you can cut your prescription costs in half. Most drugs cost just about the same regardless of the dose. For example if you take Enalapril 10 mg twice daily, you could buy the 20 mg strength, cut them in half and take ½ pill twice daily thereby cutting your cost in half.

I hope these tips help you to pinch those pennies so hard that you hear ole Abe Lincoln squeal.

If you would like to submit a question please contact Jennifer Trebler at jtrebler@ramonavna.org.

Ask the Doctor - Polypharmacy

Ask the Doctor
Leslee B. Cochrane, MD.
Medical Director
Ramona Visiting Nurse Association and Hospice

Question: My husband takes 8 different pills each day, I think that is not good but he tells me not to worry. How can you tell if you are taking too many medications?

The Pitfalls of Polypharmacy –

The term polypharmacy refers to the use of multiple medications and is a common problem in the elderly. Patients who take 5 or more drugs daily and those utilizing multiple physicians and/or multiple pharmacies are at greater risk of adverse effects. The potential for drug/drug interactions increases exponentially with the number of drugs used. In other words, taking 4 medicines is more than twice as likely to lead to problems as just taking two. Drugs can also interact with over the counter medicines, vitamins and nutritional products as well as certain foods.

When you see multiple doctors, or use multiple pharmacies, it becomes increasingly difficult to ensure that your providers have an accurate and up to date medication list. Without an accurate list, your doctor or pharmacist can not adequately review your medications to ensure you are on an optimal plan. Additionally, adverse reactions lead to increased hospitalizations not to mention the fact that taking multiple medications is just plain expensive.

There are several things you can do to reduce the risk of polypharmacy. First, place all of your medications in a bag including prescription, over the counter, and nutritional products. Take the bag with you on your next doctor visit and ask your doctor to explain why you take each medicine and to discuss the risks and benefits of discontinuing the medicine. For each medicine you keep, ask the doctor to include the indication for the medication on the prescription bottle: i.e. “Take one pill each morning for blood pressure”; this will help you better understand your medications.

Many patients find that they can safely reduce the number of medicines they take, thereby reducing risk and cost at the same time. Sharing the newly updated medication list with your pharmacist will enable them to run a drug safety profile and advise you of any interactions. Be sure your pharmacist is aware of all the over the counter medicines and vitamins/nutritional products you take as well. Educate yourself and remember: don’t be a Pollyanna when it comes to polypharmacy.

If you would like to submit a question please contact Jennifer Trebler at jtrebler@ramonavna.org.

Trust Contests - Litigation

Law Office of George F. Dickerman
3879 Brockton Avenue
Riverside, California 92501
Tele: (951) 788-2156

ELDER LAW NEWSLETTER

Trust Contests - Litigation

A trust contest occurs when someone believes that the “trustor” (the deceased person that made the trust) was mentally incapacitated and/or unduly influenced when s/he signed the trust document.

A contest petition is filed in court, and requests that the improper trust instructions be stricken.

One BIG caveat: Most living trusts contain a clause that states that any beneficiary who challenges any of the terms of the trust will be automatically disinherited. This is called a “no contest” clause.

If a beneficiary files a petition that challenges the terms of a trust, then the court can rule that the filing violated the no contest clause. The proper approach (2009) is to first file with the court what is called a declaratory relief action under the California Probate Code’s “Safe Harbor” rules. This petition asks the court to render a ruling on whether the proposed filing of a trust contest petition would violate the no contest clause of the trust. if the court rules in favor of the “Safe Harbor” petition, then (only after the applicable appeal time has run) the actual trust contest petition can be filed.

Generally, most trust contest petitions are difficult to win. The policy of the legislature and courts is to honor the intent of the trustor. The court knows that, many times, trust contests are made simply because a family member or friend of the deceased thought that they would receive a portion of the estate. When they found out they were disinherited, they got upset and automatically concluded that the decedent must have been tricked or fooled into disinheriting them.

However, there are many cases where the trustor was susceptible to undue influence or lacked the mental capacity to understand what they were doing when they signed the trust document. When this occurs, a trust contest can be filed to challenge the document’s validity.

The evidence must be focused on proving the trustor’s mental state at the time the document was signed. This can be difficult, especially when the only witness present during the signing may be the person who unduly influenced the trustor.

The test for determining whether sufficient mental capacity existed to make a trust is not a high standard, but the test is greater than that required to simply create a will. As stated, the court will bend over backwards to honor the written instructions of the trustor and to presume this is what the trustor’s wishes were. It must be shown that the trustor knew what his/her estate consisted of (house, bank accounts, furniture, etc.) and was aware of the “natural objects of his bounty”. These natural objects would be a spouse, children, brothers, sisters, etc.

If the trust made no mention of these people and, instead, instructed that all estate assets were to be given to a person that the trustor had only met a few times, a red flag would raise indicating foul play and the liklihood of undue influence.

A successful trust challenge must prove that the trustor lacked legal mental capacity. Legal mental capacity is, in large part, determined by Probate Code Section 811, which identifies numerous mental/psychological categories that must be examined to determine whether the trustor possessed the required mental capacity.

Medical records are a great source of evidence, if they have discussed the trustor’s mental capacity at or near the time that the questionable trust document was signed. It’s unlikely that you’ll find a medical document that attests to the trustor’s lack of mental capacity, and was prepared on the same day the questioned trust document was signed. However, these records can be subpoenaed and then examined to determine whether they support the case of undue influence or lack of mental capacity.

Family members and friends can also be a valuable source of evidence, particularly if these people spent a great deal of time with the trustor and were intimately familiar with his or her beliefs, wishes, mental state, and relationships with family members and others. This personal knowledge can greatly assist the court in determining whether the trustor possessed the requisite mental capacity.

Expert witnesses can also assist. Great care needs to be exercised in the selection of such an expert. This person must be thoroughly qualified and reputable in order to provide a meaningful and persuasive opinion as to mental capacity.

Given these difficulties of sufficient evidence, the law does provide a remedy when the truth is that the trustor lacked mental capacity or was unduly influenced into signing the trust document.