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Beware the Doughnut Hole

In the meantime, Dr. Lum Lung points to other low-cost solutions. At every workstation, her hospitals have posted details of the $4-a-month generic prescription programs offered by retailers like Target and Walmart. “I think it is probably prudent for us to be cognizant of that for everybody,” she says, “regardless of their insurance or payor source.”

For a recently discharged patient, one hospital Dr. Lum Lung works with proactively asked a pharmacist to run a few antibiotics through the patient’s insurance formulary to help pick the most cost-effective one. If a patient can’t afford the drug, the discharge-planning department can look into local drug assistance programs or the hospital’s voucher system, which allows medications to be filled by an in-house pharmacy. “We don’t want to—especially right now—make somebody have to make a choice between making their mortgage or rent payment or paying for a very expensive medication,” she says.

With so much information coming at them at once, hospitalists say, patients may need to be monitored once they get home. And with limited medical resources, physicians must constantly ask themselves whether they’re using the most appropriate and least expensive medications for every patient. “The hospitalists, in particular, are the natural leaders for this kind of thinking,” Dr. Koretz says. “Thinking about medical problems not as isolated, patient-specific problems, but rather as problems of systems of care, and processes of care.” TH

Bryn Nelson is a freelance medical writer based in Seattle.


  1. Madden JM, Graves AJ, Zhang F, et al. Cost-related medication nonadherence and spending on basic needs following implementation of Medicare Part D. JAMA. 2008;299(16):1922-1928.

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