Forgetting to Take Those Medications

Traveling with Medications Safely, Effectively and Hassle-FreeAlthough this article pertains to all ages who need to leave town with prescription medications, it is especially relevant to the active 55 plus community.  Lets be honest, as we get older, we often require more medications to treat a variety of illnesses.  In many instances, we are also taking care of a spouse, parent or other dependent when we travel, and must ensure they have all the required medications for travel as well.  The following are some tips to employ as you embark on your next adventure.  Simple planning ahead can save you from a host of problems, while helping you maintain your productively aging lifestyle.  Here are some things you can do before your trip, during your trip and after your trip to avoid medication pitfalls while you are away from home.Before your TripFirst, determine the number of days you will be gone and add at least an extra week to determine what you will need as a rule of thumb.  This can account for medication emergencies, travel delays, or other unforeseen circumstances.  Medication synchronization is a process that allows you to pick up all your medications at the same time.  If possible, ask your pharmacy about medication synchronization well in advance of your trip.  If you take the time to talk with your physician or pharmacist, this process can streamline your medication pick-up to all at once.  I often encourage patients to use mail order weeks in advance of their trip. This often provides greater quantities with fewer copays.  Also, ask your pharmacist if there have been any supply issues or manufacturer shortages with your medications.  If so, discuss with your doctor therapeutic alternatives you could try in the interim.  Certain medications, such as controlled substances (pain medications or stimulant medications) often have supply restrictions and are not afforded refills.  Tell your doctor to communicate to the pharmacy that it is ok to fill these medications early.  Remember, we cant just take your word for it that you are allowed to take the controlled substance early.  The doctor should preferably communicate via phone, electronic prescribing, or on the prescription that it is ok to fill these medications early. DO NOT (I repeat DO NOT) order your medications on your travel day or arrange to pick up medications on travel days (unless absolutely necessary)!!!!  You dont want to miss a flight due to poor planning and get stressed by having to deal with medication issues (air travel is already stressful enough nowadays).  Murphys Law, which states anything that can go wrong, WILL go wrong, applies to picking up medications at the pharmacy on your travel date.  This could range from being out of refills, the prescription expiring (in Colorado, prescriptions expire after a year, even if you have unlimited refills), the medication being on shortage or backordered, the doctor may have not put in the correct dose or many other issues that could arise.  Give yourself some comfortable leeway for medication pickup prior to your fun departure.  This is especially relevant around major holidays, such as Thanksgiving and Christmas, in which your doctor may be away, and pharmacies and health clinics may be closed!!  Before your trip have a written list of all your medications to take with you.  If you are tech savvy, try the HERO app (which is through Hero Health, Inc) and input your medications and their directions.  This may be convenient if you are being asked about your medications during your travel or in case of emergency. Be sure to have a list of pertinent medical information readily available on your person, or with a spouse (such as drug and food allergies, medical conditions such as epilepsy or any other things a medical professional would need to know in case you become unconscious or ill during your trip).  Although it goes without saying, make sure to include supplies and diagnostic materials when you travel (nebulizers, diagnostic kits such as blood glucose meters, needles etc).  Look at your itinerary, before your trip, and try to determine if there are situations that could cause you to either forget your medications or could create problems.  Remember, your disease or conditions dont take a vacation, so it is very important that you adhere to your medicines, so you dont end up with nightmares.  Before you go on your trip, investigate how to obtain the same or equivalent medications before departure, in case a replacement is needed due to loss, inadequate supply due to travel interruptions, or the need to resupply maintenance medications if the trip is long-term.  Make sure you have your physician/health insurance information in case you have a medical emergency away from home.  When traveling outside the country some hotels and resorts have medical staff on hand to assist with medical emergencies.  Try to get information on what these medical staff may offer prior to your trip.  They may be invaluable in instances of lost or stolen medications.  What about travel to foreign countries, what things do you need to consider?  Pharmaceutical regulations vary from country to country. Some countries have limited availability of certain drugs or prohibit their importation. In addition, travelers should not plan to have someone mail (including express couriers) medications to them.In the US, it is not legal for an individual to mail prescription drugs anywhere. In addition, other countries may have restrictions on unregistered drugs (i.e., medications not approved for use in that country) coming into their country by mail. Controlled substances and psychotropics are completely prohibited in some countries (e.g., the United Arab Emirates, Japan, Zambia), and possession of even a small amount of these substances for personal use may result in arrest, incarceration, and charges of drug trafficking. In some countries, controlled substances are not available at all for outpatient use (except cancer patients), even with a local doctor's prescription.A limited number of countries (e.g., Japan, Zambia, United Arab Emirates) prohibit certain common prescription medications as well as commonly used over-the-counter medications; these cannot be imported nor are they available. This includes ingredients found in inhalers and cold, cough, allergy, and sinus medications (e.g., diphenhydramine; Benadryl). Banned ingredients may also include those deemed to be stimulants, such as pseudoephedrine, levomethamphetamine, the common cough suppressant dextromethorphan, and dextroamphetamine (e.g., Adderall).  I advise checking with the destination's embassy about any med restrictions before travel...especially with controlled substances. Again, make sure that you are taking care of your health, even on vacay.Beginning and during your TripDuring your travels ALWAYS keep track of those carry-ons that contain your medications.  I like to put special ribbons on my carry-on and have my spouse and I double check our bag counts as we go from one point in our trip to the next (ie shuttles, boarding and deplaning).  Try to keep these personal belongings within your eyesight.  If you can, try to keep your medications in the original containers.  Although, TSA doesnt have a rule against pill boxes (and you can travel with them filled with your meds), the latches can come undone, and scatter medications throughout your carry-on.  It is a good strategy to use your pill boxes once you get to your destination, as it can help you keep track of your medications and prevent you from skipping medications.  Speaking of carry-on, that is the only place your medications should be stowed away in.  NEVER put your medications in your checked bags.  At TSA, I have had to carry a nebulizer machine for asthma.  I anticipate that they may want to observe the product (it looks like a bomb) so I put it separately in a bin with the carrying case ajar.  The same would go for diabetic supplies and instruments. You may bring medically necessary liquids, medications, and creams more than 3.4 ounces or 100 milliliters in your carry-on bag. Remove them from your carry-on bag to be screened separately from the rest of your belongings.  Try to keep your medications packed efficiently and in a neat manner (dont have stuff strewn about your carry-on or purse, or meds out of their bottles).  When you reach your destination store your meds safely and properly.  This is done by keeping them in a dry area without sunlight.  In your hotel, try to keep controlled substances (such as pain medications) out of plain sight, as they are targets for theft.  Do not talk about your pain medications in public, this could make you a target to unsavory people. Regarding theft or loss of medications use the pharmacy information you gathered before your trip (see Before your trip section) and contact your physician or home pharmacy to get a transfer.  If you are out of the country contact the resort medical director or the U.S. embassy in case of medication loss as well as law enforcement if there is suspected theft.  In many countrieseven those that require a prescriptionpharmacists may have the latitude to provide short-term or emergency refills (generally for a more common, benign, chronic medication) without a prescription.  While away for pleasure, it is easy to eat, or drink in excess.  Do know your limits and set reasonable goals.  If you must visit a medical facility or urgent care while on vacation, DO KEEP the billing information as you may be able to get reimbursed by your primary home insurance.  Again, your medical conditions do not take a vacation, and you want to stay healthy to take even more vacations.  When traveling, I have heard that clients/patients get excited when they see prescription medications being sold over the counter (OTC).  It is tempting to purchase these items as they are often cheaper and readily available.  Please note that foreign health agencies do not test as rigorously for the veracity of active ingredients (as well as other properties of the medication).  There is a high probability of counterfeit medications. The Los Angeles Times, recently reported in 2022 that 55 pills purchased from 29 pharmacies in eight cities in Mexico were tested, and more than 50% of the pills were determined to be counterfeit. More than a third of the 40 opioid pain medications purchased tested positive for illicit fentanyl rather than a prescription opioid medication. Twelve of 15 Adderall samples tested positive for other substances, including methamphetamine and ecstasy. Sometimes entire bottles that appeared to be factory-sealed were tainted.  In fact, when abroad, check with the local embassy to ensure a pharmacy is trustworthy and to get tips on obtaining medications that are not counterfeit.  In some developing countries you may also see antibiotics sold as OTC items. It is a bad idea to get a random antibiotic to treat what is ailing you.  For one, the antibiotic may not be ideal (even if you used it in the past) as there can be resistance, and it may be questionable if the product has the true dose content or could be counterfeit.  If you have an infection, it is best to see a doctor abroad who can at least direct you to trusted sources of medications and can use clinical judgement to determine the nature of the infection, and if there are risks that you have not thought of.  Remember that antibiotics are often used to treat specific bacteria.  If you try to use an antibiotic for a viral infection, it WILL BE ineffective, as antibiotics treat bacterial infections. Lastly, before leaving back home, ensure you pack your meds as you did before your trip.  On my last day of travel, when I am packing, I do a run through of my hotel room to make sure I have not forgot any important items (medications etc).  DO NOT discard empty prescription bottles with your medical info away in the trash.  Your prescriptions with your name, and medications can be used to commit fraud against you.  Do a bag checklist as you did previously.After your tripPut your medications away as soon as you can.  It is easy to get off track when you get back from vacation, but remember, your conditions dont take a vacation.  Be sure to submit billing receipts and to contact your insurance if you incurred medical expenses while on vacation.  While it is not a guarantee that you will get reimbursed, it is important that you submit your claims as soon as possible.  People often experience sickness after travel due to exposure to large crowds (such as in airports or on cruises).  Go see your physician immediately (especially if you have immune disorders or are on chemotherapeutic agents) to insure you are treated promptly.  Viral infections generally have a small window of time for treatment (such as COVID-19 and influenza).  Do get back to your normal diet as you likely indulged during your trip. I hope these tips were helpful!!!  As always, enjoy life, but stay healthy and happy in 2024.Sincerely,Keith Williams (Your personal pharmacist)Owner of Deeper Dive HorizonsVisit deeperdivehorizons.com for details on how I can help you navigate the health care world!!!

  Seasonal allergies can affect seniors just like people of any age. Older adults may experience symptoms such as sneezing, runny nose, and itchy eyes due to allergens like pollen and dust. While some seniors may experience a decrease in seasonal allergies as they age, others may find their allergies worsening with time. It is important for seniors to manage their allergies effectively to avoid discomfort and potential health concerns. As seniors age, their immune systems may become less effective at fighting off allergic reactions, making them more susceptible to mild symptoms triggered by allergens such as pollen. Here are a few common Over-the-counter medications that you can use to manage seasonal allergies: Nasal steroids: These include Flonase (generic is fluticasone), and Nasacort (generic is triamcinolone). These medications are generally considered the first-line treatments for allergies. Doctors and pharmacists prefer these treatments for moderate to severe or persistent allergy symptoms. These treatments are also beneficial for itchy, irritated or watery eyes as well as nasal congestion.2ndgeneration Antihistamines: These medications which include Claritin (generic is loratadine), Allegra (generic is fexofenadine) and Zyrtec (generic is cetirizine) are good for milder allergy symptoms, or those symptoms that occur occasionally. It is very important that seniors stick with the 2nd generation antihistamines and AVOID Benadryl (generic is diphenhydramine) or Chlor-Trimeton (generic is chlorpheniramine). Antihistamines such as Benadryl can cause excessive sedation, worsen glaucoma, and promote increased fall risk in elderly patients. Therefore, it is best to avoid Benadryland Chlor-Trimeton when you get older.Nasal Antihistamines: These include brands Astepro and Astelin, and these medications are considered add-ons to nasal steroids. If you are still suffering from allergy symptoms while on a nasal steroid, these may provide additional help.Ophthalmic antihistamines: For those with watery or itchy eyes, in which nasal steroids are not quite enough, medications such as Zaditor (generic ketotifen) or Pataday (generic olopatadine) are eye drops that can provide additional benefit.Lastly for uncontrolled nasal congestion one can consider nasal decongestant medications such as Afrin (generic is oxymetazoline). Realize there are some warnings with these medications. They can cause rebound nasal congestion if used for 3 days or more. Reserve this medication for nasal congestion that does not respond to nasal steroids, or for the occasional nasal stuffiness. If you have uncontrolled high blood pressure, avoid this medication.The management of seasonal allergies includes nonpharmacologic and pharmacologic approaches. Nonpharmacologic measures include nasal irrigation and allergen avoidance (e.g., keeping windows closed, using window screen filters and air conditioning, limiting outdoor time during peak allergen season, showering after outdoor exposure). Choose a medication based on severity of symptoms, patient age, other medical conditions, and preferences.  Immunotherapy (subcutaneous or sublingual) can be considered if other management is not adequate or if the patient has seasonal allergies in combination with asthma. Alternative therapies (e.g., supplements, homeopathy, and acupuncture) have been used and promoted for seasonal allergies; however, there are insufficient data to recommend these therapies.--------------------------------------------------------------------------Seniors can help manage their seasonal allergies by incorporating an immunity-boosting diet that includes foods like apples, strawberries, ginger, leafy vegetables, walnuts, and fatty fish. It is crucial for caregivers of seniors to be aware of how seasonal allergies can impact older adults and provide the necessary care and support.If you are a senior or a caregiver of a senior experiencing seasonal allergies, it is recommended to seek guidance from healthcare professionals on how to effectively manage and alleviate allergy symptoms. Implementing strategies to minimize exposure to allergens and incorporating healthy lifestyle habits can significantly improve the quality of life for seniors dealing with seasonal allergies.As we grow older, our body changes and so does our immune system. Just as we no longer run as fast as we once did, we may lose our tolerance to potential allergens, from pollen to dog hair. And, on the flip side, we may build immunities to the things that once bothered us, research shows.  Nasal antihistaminesSee a comparison of nasal sprays for allergic rhinitis later in the document.Add-on therapy with nasal steroids, if needed (especially for nasal congestion).1,3,8Under two years (Astepro [US]) or under five   years (Astelin [US]).9Under six years (olopatadine).9Neither available as single-ingredient nasal sprays in Canada. Ophthalmic antihistaminesAdd-on therapy for eye symptoms with nasal steroids, if needed.1Under three years (ketotifen, olopatadine [Canada]).9,15,16Under two years (olopatadine [US]).9 Decongestants (intranasal, oral)Inadequate response from a nasal steroid for nasal   congestion.2Use in combination with an oral antihistamine  (intranasal).3Intermittent nasal congestion.2Hypertension, arrhythmia, coronary heart disease, hyperthyroidism, glaucoma, diabetes, and benign prostatic hypertrophy (oral).2Prolonged use (more than three to five days) (intranasal).2,3With monoamine oxidase inhibitors.6Monotherapy (intranasal).6

Key Takeaways:An increasing number of older Americans struggle to afford the prescriptions they need to manage their conditions and stay healthy.As part of the Inflation Reduction Act, Medicare can now negotiate prices directly with drug companies to lower costs for both enrollees and taxpayers.Learn what this and other Medicare prescription drug changes mean for you or an older adult you care for. An increasing number of older Americans cant afford the prescriptions they need to stay healthy. In a recent study, roughly 1 in 5 people age 65+ took shortcutssuch as skipping doses or delaying refillsdue to financial worries.1 Said President Biden in a statement: For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear. That could soon change as a result of the Medicare Drug Price Negotiation Program. If you have Medicare, keep reading to find out how (and when) this program may affect you or an older adult you care for. What is the Medicare Drug Price Negotiation Program? The Medicare Drug Price Negotiation Program is part of the Inflation Reduction Act (IRA) of 2022, which includes several provisions to help lower prescription drug costs for people with Medicare. This provision will allow Medicarefor the first time everto negotiate drug prices directly with pharmaceutical companies. The goal is to improve the affordability of some of the most expensive drugs covered under Medicare Part B and Part D. Part B covers drugs administered by a physician. Reduced prices from drug negotiations for the first 10 drugs will take effect starting in January 2026. Going forward, the Centers for Medicare & Medicaid Services (CMS) will then select:         Up to 15 additional drugs to negotiate for 2027         Up to 15 additional drugs (including those under Part B) for 2028         Up to 20 additional drugs for 2029 and subsequent years Todays announcement is a game changer for the millions of older adults who rely on these medications every day," said Ramsey Alwin, NCOA President and CEO, in a statement on the start of drug price negotiations. "Our research shows that the cost of chronic conditions falls heaviest on women and people of color, who have the fewest resources. Lower prices are a matter of equity." A recent KFF survey showed strong bipartisan support (83%) for allowing the federal government to negotiate drug prices. Which prescription drugs will be negotiated? The drugs that qualify for Medicare price negotiation are from a list of high-cost, brand-name, single-source drugs that have no generic competition on the market. In 2022, Medicare enrollees paid a total of $3.4 billion in out-of-pocket costs for these medications. The 10 drugs selected for the first round of Medicare negotiation:         Eliquis: For preventing strokes and blood clots         Jardiance: For type 2 diabetes and heart failure         Xarelto: For preventing strokes and blood clots         Januvia: For type 2 diabetes         Farxiga: For chronic kidney disease         Entresto: For heart failure         Enbrel: For arthritis and other autoimmune conditions         Imbruvica: For blood cancers         Stelara: For Crohns disease         Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill: Insulin products for diabetes How will these changes affect me? Once fully implemented, the Medicare Drug Price Negotiation Program is expected to drop prices on negotiated drugs for up to 9 million older adults, who now pay as much as $6,497 out of pocket each year for these medications. People with Medicare will have better access to prescription drugs that help them manage chronic and life-threatening conditions. More older adults will be able to start medications, take them appropriately, and stay on them without making potentially dangerous trade-offs. Experts predict the program will also save taxpayers $160 billion by lowering Medicare costs. Other Medicare prescription drug provisions In addition to drug price negotiation, there are several other important provisions in the Inflation Reduction Act designed to lower healthcare costs for people with Medicare. Several provisions have already taken effect:         Medicare will cover a greater portion of the cost for high-quality biosimilars (drugs made from a natural source) for a period of five years, which began October 1, 2022.         Monthly out-of-pocket cost sharing for insulin is capped at $35.         Vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are 100% free.         Drug manufacturers that raise their prices at a faster rate than inflation will face a financial penalty. Starting in 2024:         The 5% coinsurance for catastrophic drug costs will be eliminated.         Eligibility for the full Medicare Part D Low-Income Subsidy (LIS, also called Extra Help) will be expanded to beneficiaries with incomes up to 150% of the federal poverty level. LIS lowers premiums and out-of-pocket costs for prescription drug coverage.         From 2024-2029, annual Part D premium increases will be capped at 6%. Starting in 2025:         There will be a $2,000 annual cap on drug out-of-pocket costs. This could save beneficiaries $400 each year on prescription drug costs. Enrollees with the highest out-of-pocket drug costs could save $2,500 per year. In addition, the Medicare Prescription Payment Plan provision will allow enrollees to pay their out-of-pocket prescription costs in the form of fixed monthly payments over the course of the plan year (instead of all at once). These key provisions will help promote equitable aging by making vital medications affordable for more older Americans, says Josh Hodges, NCOAs Chief Customer Officer. Reducing drug costs will serve to improve the Medicare program now and ensure it remains strong and solvent for future enrollees. The Inflation Reduction Act also extends premium subsidies for the Affordable Care Act (ACA) Marketplace into 2025. As a result, an estimated 10 million people will save about $700 annually on their healthcare premiums. Source 1. Stacie B. Dusetzina, PhD et al. JAMA Network. Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022. May 18, 2023. Found on the internet at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805012This article was written by the National Council on Aging, September 14, 2023.