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Purchase erythromycin for a year would cost about $1,200 after taking into account generic pharmacies and doctor's office fees. If the drugs are purchased in bulk, as with co-purchase agreements and pharmacy benefit managers, this price would be lower. "A year's cost [to a patient] would be lower," Cohen said. Although a patient may not understand the risk of antibiotic use with this type of disease, that patient can and should have that conversation with their physician, she added. The Affordable Care Act has already included the idea of generic drugs, but there is no guidance on how to implement co-purchase agreements. In fact, Cohen said those discussions have been largely nonexistent. "The ACA was very vague on how we would get to a situation where every health-care worker was a professional in one, but then how they would negotiate or purchase a medication," Cohen said. "We are really just now starting to see a few examples. I expect more will come." "I thought generic drugs were affordable but I'm glad not paying that high for the drugs I need now." If co-purchase agreements for antibiotics start to spread as a result of the Affordable Care Act, they need to be properly implemented, said Dr. Susan Taylor, assistant professor of internal medicine at Johns Hopkins University Feinberg School of Medicine. "It is important for providers to make sure that a patient's doctor is aware of alternative choices," she said. Cohen said it is "possible" to start a collaborative agreement in place before the finalization of Medicare Part D and coverage begins Jan. 1, 2012. The key Erythromycin tablets buy uk is having a good agreement in place, which can take several steps. Cohen recommended that the pharmacist or physician negotiate upfront, and that the physician pharmacist have a separate phone call to go over details of what would be covered under a collaborative. If there isn't one, Cohen said it is important for providers to set aside a time and place to discuss the possibility of sharing a product. "I made sure there was a separate time just for my doctor to be able discuss a generic with me without that person saying, 'Well, we might need to share,'" Cohen said. "We also had this time when I was able to educate her on the importance of going into a health-network plan." It is imperative that both doctors and pharmacies know the difference between a generic and brand name drug in order to work with patients more effectively, Cohen said. "Sometimes patients are reluctant to ask about generic drugs," Cohen said. "They want to know if there are any additional costs; that their insurance coverage is different than what they have; or it may take a while to fill the prescription because of generic. "I made sure they understood the differences between two and it was up front." [A previous version of this essay co-authored by Stephen Miller was posted here.].

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