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Daily medication is the cornerstone of evidence-based therapy to reduce mortality and morbidity in patients with heart failure (HF). Up to 20% of Canadian patients pay for medications out of pocket. We sought to identify strategies that patients and prescribers can employ to reduce these costs. We collected data from outpatient pharmacies in Hamilton, Ontario. We determined prices for different medications in each of the drug classes recommended for HF with reduced ejection fraction in the Canadian Cardiovascular Society’s guidelines. We examined differences in dispensing and delivery fees and inquired about other cost-saving strategies. We collected data from 24 different pharmacies, including a selection of hospital-based, independent, and larger chain pharmacies. In the most extreme scenario (i.e., 90-day prescription instead of a 30-day prescription and the least expensive generic drug instead of the most expensive brand name drug), total medication costs can differ by up to $495.56 per month. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee, and delivery cost. Prescription content, dispensing practice, and pharmacy choice can remarkably impact out-of-pocket costs for HF medications. Prescribers can reduce costs by writing 90-day prescriptions and choosing the lowest-cost generic drugs in each therapeutic class. Patients should consider the services received for their pharmacy dispensing fees, use free delivery services where needed, and request inexpensive generic drugs. Pharmacists can facilitate cost minimization without compromising therapeutic efficacy.

Daily medication is the cornerstone of evidence-based therapy to reduce mortality and morbidity in patients with heart failure (HF). Up to 20% of Canadian patients pay for medications out of pocket. We sought to identify strategies that patients and prescribers can employ to reduce these costs.We collected data from outpatient pharmacies in Hamilton, Ontario. We determined prices for different medications in each of the drug classes recommended for HF with reduced ejection fraction in the Canadian Cardiovascular Society's guidelines. We examined differences in dispensing and delivery fees and inquired about other cost-saving strategies.We collected data from 24 different pharmacies, including a selection of hospital-based, independent, and larger chain pharmacies. In the most extreme scenario (i.e., 90-day prescription instead of a 30-day prescription and the least expensive generic drug instead of the most expensive brand name drug), total medication costs can differ by up to $495.56 per month. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee, and delivery cost.Prescription content, dispensing practice, and pharmacy choice can remarkably impact out-of-pocket costs for HF medications. Prescribers can reduce costs by writing 90-day prescriptions and choosing the lowest-cost generic drugs in each therapeutic class. Patients should consider the services received for their pharmacy dispensing fees, use free delivery services where needed, and request inexpensive generic drugs. Pharmacists can facilitate cost minimization without compromising therapeutic efficacy.

Research describing opioid misuse in children after surgery currently describes single specialties, short follow-up, and heterogeneous data not conducive to comparative discussion. Our primary objective was to quantify opioids prescribed to pediatric surgical patients on discharge from hospital. Secondary objectives were quantifying opioids remaining unused at four-week follow-up, and family attitudes to safe storage and disposal.We conducted a prospective observational study under counterfactual consent with telephone follow-up at four weeks of children who had undergone a surgical procedure and filled an opioid prescription at The Hospital for Sick Children, Toronto, ON, Canada. Exclusion criteria included opioid use within the previous six months, history of chronic pain, or discharge to a rehabilitation facility. Pre- and post-discharge prescribing, dispensing, and consumption data were collected prospectively in addition to parental reports of home opioid use. Opioid-dosing was converted to oral morphine milligram equivalents (MME).There were 8,672 MMEs prescribed to 110 patients. Twenty-one patients were lost to follow-up, accounting for 1,416 MME. Of the remaining 7,256 MME, 67% went unused. At follow-up, 78% of unused opioid remained in the home. Most opioids were stored in an easily accessible location in the home.These findings confirm overprescribing of opioids to pediatric surgical patients. Families tend not to return opioids that exceed post-discharge analgesic requirements at home and many of the reported disposal methods are unsafe. We recommend future studies focus on optimizing opioid prescriptions to meet, but not excessively surpass, home pain management requirements, and to encourage safe opioid disposal/return methods.www.clinicaltrials.gov (NCT03562013); registered 7 June, 2018.RéSUMé: OBJECTIF : La recherche s’intéressant à la mauvaise utilisation des opioïdes après une chirurgie chez des enfants décrit actuellement des spécialités uniques, un suivi de courte durée et des données hétérogènes ne permettant pas de déboucher sur un débat comparatif. Notre objectif principal était de quantifier les opioïdes prescrits à des patients chirurgicaux pédiatriques au moment de leur congé de l’hôpital. Les objectifs secondaires étaient de quantifier les opioïdes inutilisés restant après quatre semaines de suivi et l’attitude des familles envers un stockage et une élimination sécuritaires. MéTHODES : Nous avons réalisé une étude observationnelle prospective sous consentement contre-factuel avec suivi téléphonique à quatre semaines d’enfants qui avaient subi une procédure chirurgicale et avaient reçu une prescription honorée d’opioïdes au Hospital for Sick Children de Toronto (ON, Canada). Les critères d’exclusion étaient l’utilisation d’opioïdes dans les six mois précédents, des antécédents de douleur chronique et un congé vers un établissement de réadaptation. Les prescriptions avant et après le congé, les données de remise et de consommation des médicaments ont été collectées de manière prospective en plus des rapports parentaux sur l’utilisation des opioïdes au domicile. Les doses d’opioïdes ont été converties en milligrammes équivalents de morphine (MEM) orale. RéSULTATS : Il y a eu 8 672 MEM prescrits à 110 patients. Vingt et un patients représentant 1 416 MEM ont été perdus au suivi. Sur les 7 256 MEM restants, 67 % n’ont pas été utilisés. Au suivi, 78 % des opioïdes non utilisés étaient encore au domicile. La majorité d’entre eux étaient conservés dans un endroit facile d’accès au domicile. CONCLUSION : Ces constatations confirment la prescription excessive d’opioïdes aux patients chirurgicaux pédiatriques. Les familles ont tendance à ne pas rapporter les opioïdes qui dépassent les besoins analgésiques après le congé et un grand nombre des méthodes d’élimination indiquées ne sont pas sécuritaires. Nous recommandons de concentrer les études futures sur l’optimisation des prescriptions d’opioïdes afin de satisfaire, mais sans dépasser de façon excessive, les besoins pour la gestion de la douleur au domicile et d’encourager des méthodes de retour/élimination sécuritaire des opioïdes. ENREGISTREMENT DE L’ESSAI CLINIQUE : www.ClinicalTrials.gov (NCT03562013); Enregistré le 7 juin 2018.