Food Allergies and the Pharmacy


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Bottom of the Barrel

While traveling with E and A today, I visited one of Cracker Barrel‘s 600 locations.   E has never eaten at the Cracker Barrel but since so many restaurants have embraced the challenges of providing for allergic customers I thought I would give it a go. Welp…a half hour (and 3 bathroom breaks with a potty training 3 year old) later, we left with empty bellies, frustration, and PICTURES.

I will start with the positive. I appreciate the language added to the internal reference that specifies that the servers refer food allergy questions to a manager. I also appreciate the mention of cross contamination and the attention given to educate the server that even a small amount of a food allergen could be “life threatening” for some people.

Why did I italicize and bold internal?

Apparently, the Cracker Barrel feels that the customer should not be allowed to read its poorly developed and horribly executed allergy menu. The food allergen reference even specifies that “it should not be given to the guest or posted for public reference.”  Cracker Barrel even goes as far as to state that the server (or manager as it would seem) “must review ingredient labels and take extra care to prevent cross-contamination.”

I didn’t know any of this valuable information when I sat down. I didn’t know that I would have a server “suggesting” menu items to me off the “allergy menu” that I requested but was not allowed to read.

My waitress would not give me the menu, at first.

I simply explained that I deal with my son’s allergies every day and that there are several names for each allergen. I know these names. If you are reading this blog, you probably know them too. She, however, does not. And since I was not allowed to read the “menu,” I did not know how the information was listed or provided.  I convinced the waitress that I should be the one reading the menu.

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Maybe Homa Woodrum could shed more light on this but I would assume that having the server/manager translate an allergy menu and specifically suggest food items would actually be more of a liability to the corporation.  This is even more poignant given the fact that the allergy menu specifically states that it should not be shown to the customer.

Another issue that gets me heated is their attempt to educate the waiter (who is then to educate the customer since the customers aren’t allowed to read the paper?) on the recommendation for the guest to “discuss with a physician” the need to avoid soy lecithin and soy oil.   Within the paperwork, I found a statement referencing the “Food Allergy and Anaphylaxis Network” which we know merged with the “Food Allergy Initiative” in 2012 to become FARE (Food Allergy Research and Education).  In the upper right hand corner of the menu the “revised” date of October 2013 can be seen.

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So, not only was this menu updated with outdated information even at the time of its revision but also, it has not been addressed for a year and a half. Could it be possible that food venders, and potentially the food ingredients themselves, have changed over the course of a year and a half?  I think yes.

The FAAN statement talks about how soy lecithin and soy oil are not “indicated as allergens.” I guess this absolves the Cracker Barrel of the need to disclose these ingredients in the so-called allergy menu.  My son reacted to the type of soy oil to which most people do not react. I don’t need nor do I want lectured on soy from the waitress at the Cracker Barrel. I want ingredients. I want a clear, easy to understand menu that is updated frequently and does not talk down to me or belittle an allergen that is important in my family.

Needless to say, we did not eat there.  Additionally, I would not recommend any person with food allergies or sensitivities to consider Cracker Barrel unless some serious, extensive changes are made.  First and foremost, the customer should ALWAYS be allowed to read the ingredient list. Restaurants should be transparent with all aspects of food prep and content.  I am not talking about specific recipes of proprietary ingredients but simply the basic list of included food.  ALL food. Any and everything used in the making of the food. Period. Simple.


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Best Bang for Your Medication Bucks: Part 3

Part three of the series will focus on how the pharmacy can help you navigate and negotiate the best medication price and situation for you.

 

Pricing:

Some manufacturers/pharmacies have medications for one set price regardless of strength. Thirty of the 50 mg tablets may cost the same as thirty of the 100 mg tablet. This may be beneficial to you. Depending on the release mechanism, certain medications can be cut in half. Not all medications. Please do not just assume that a medication can be safely cut–always speak with your pharmacist first.

The pharmacist can process the scenarios to see which option would be the most beneficial. This may take a while. Ask the pharmacy staff to run the numbers and call you at a later time. You don’t want to rush him/her because options may be missed plus it’s just rude.  Please remember that the pharmacist may have several people asking for this service, in addition to doctor’s offices holding to give new prescriptions, vaccines to administer, interactions to call on, patients to counsel at pick up, a sick child’s medication waiting to be filled, the list goes on and on.

If you are using insurance, then this process becomes a bit more tricky. You will need to call the customer service number on the back of your card. Customer service will be able to provide you with a copy of your plan’s formulary (the list of medications covered and how much they cost). The formulary is the best way to evaluate medication coverage and cost when dealing with an insurance company. The plan formulary should be taken to each doctor appointment; this one step could save the doctor, the pharmacist, and ultimately you a lot of time and frustration (as in the case of prior authorizations, non-formulary and therefore higher priced meds, or medications that are just simply not covered at all).

Combination medications:

Some medications are offered singularly and also in combination; examples include lisinopril/hydrochlorothiazide, metformin/glyburide, and Janumet (Januvia/metformin). There are many reasons to take combination products such as ease of use, decreasing number of tablets taken per day, adherence (which is just a fancy word people in medicine use for saying that a person takes the medication every day as directed), and price.

Sometimes the price is a positive aspect of a combination product and sometimes it is a negative; for the purpose of this post I will only focus on price.

Knowing the right questions to ask will come in handy:

1. Do these individual medications come in a combination product?  Conversely, does this combination product come as individual medications?  If you have insurance, I would first look at the formulary for pricing, if not, ask the pharmacy staff to price out the individual medications and the combination.

2. Could I have a higher strength and cut it in half? What would be the cost?

3.  Is there another product in the same category of medication that costs less?  For example beta-blockers are a type of medication often used for blood pressure and heart rate control. There are several medications within this category: metoprolol, propranolol, nadolol, atenolol, etc. Additionally, metoprolol is found in an extended release version and an immediate release version. Extended release is more expensive but may only need to be taken once per day. Immediate release is less expensive and often taken multiple times per day. The choice becomes one of price vs convienence.

**Please take into consideration that not all medications within the same category will work for all people.  Even though medication A may be the least expensive, some patients may need Medication B for a variety of reasons including  effectiveness, side effects, lack of an appropriate choice for allergens, or drug interactions.  Your pharmacist and prescriber can weigh the pros and cons of one form or another and discuss which would be the most appropriate choice for your particular circumstance.

Why you should NOT Coupon Shop

First and foremost, in my opinion, hopping from pharmacy to pharmacy for $25 here and there is NOT SAFE. Large retail pharmacy chains often offer a cash incentive for transferring prescriptions but (and this is a huge BUT), pharmacists are unable to see your entire medication list when some are filled at Kroger, some at Rite Aid, and others at CVS, Walgreens, or the local independent. What this means is that interactions may and WILL be missed.

Another reason to find the pharmacy and pharmacist best for you and stick with him/her is due to allergy or intolerance issues. Pharmacy data bases are not currently equipped to handle these issues and the pharmacist must manually check the package inserts and potentially call the manufacturer to make sure that each medication is safe for the allergic patient.

Having a pharmacist that knows your special circumstances and goes above and beyond to ensure your or your child’s safety is invaluable.