A 60-year-old man who had been in good health went to the emergency room, complaining of nausea. He was diagnosed with high blood pressure, high cholesterol, and early diabetes. ER doctors were able to relieve his nausea at the hospital, but the man left with five prescriptions (four brand-name drugs and a generic) to treat his new ailments.

The upbeat attitude he had about his health turned to shock when he went to fill the prescriptions at his local pharmacy: His total bill was $300 for the first month's supply. The patient, who lacked prescription-drug insurance, couldn't afford that, nor could he afford to see a different doctor. He was referred to me at a Veterans Affairs clinic in Oregon. After examining him, I focused on how he could receive the best care within his financial means.

Cost is rarely a favorite topic in a doctor's office. Some patients are shy about discussing medical costs, but I knew I had to talk with my patient about money. And given the current recession, he's probably not the only person in such tight circumstances.

Cutting back

I explained my three Rs for economizing on prescriptions. Here's what we did:

1. We removed one of the three blood-pressure drugs, a brand-name medication that had some side effects that the patient wasn't aware of. We decided to try the two others first and add the third if needed.
2. We replaced the three remaining brand-name drugs with generic medicines. Although the generics were not identical to the brand-name drugs, they were quite similar. I was aware of evidence that in all three cases, the drugs would be just as effective. Since those drugs had been sold for some time, I could assure him about their side effects.
3. We reconciled over-the-counter and natural medicines or supplements that he took with the new medicines. The patient mentioned that a doctor gave him another drug for a prostate infection, which he hadn't noted earlier. I advised him to stop taking the drug, since he didn't need it and it could conflict with his new medicines. If the prostate ailment recurs, there are other medicines that would complement his new regimen.

The patient was now on four (instead of five) medications, and they were all lower-priced but just-as-effective generics.

A good outcome

The Veterans Affairs clinic's pharmacy offered each of his four medicines for $8, for a total of $32 a month, about 90 percent less than the cost at his local pharmacy. Three of the four generic medicines were available at his local pharmacy as part of a $4-per-prescription special, and the fourth was available for $10. He decided to fill the prescriptions locally, where the cost of his medications totaled $22 a month. If the special ended, the Veterans Affairs' pharmacy would be a good fallback.

The patient did well medically and was able to afford all the prescriptions he needed. He never had to take the third blood-pressure drug. When his prostate infection recurred, he was prescribed a generic medicine that worked well with the others. He realized that comparison shopping for medicines can pay off. The best part of our success? Patient and doctor teamed up to do this together.