Dr. Jason Kim

Unfortunately, in younger patients, a lot of times insurance will mandate that we give them anticholinergics.

I've been lucky that usually for patients in my practice and the insurance plans in the area, if they require a non-beta-3, it's usually one.

I'm not going to say that's always the case, but for the most part, it hasn't been problematic.

I know it's a pain, but if we have a significant justification for using beta agonist, we usually challenge the insurance company, especially in the older patient cohort.

And let me make the point.

In my practice, if they fill one anticholinergic, I'm done with anticholinergics.

I'll move on to a beta agonist.

I don't like to play the game where you're cycled on multiple anticholinergics for years.

Yeah.

I mean, typically for me, medications, once I started doing medication, I haven't followed that up in four weeks.

I usually can tell within a short time.

I don't want patients out there for months trying medications if it doesn't work.

It leads to frustration.

I think some of the hopelessness that these patients see.

Yeah, this is where shared decision-making comes in.

You know, if a patient was starting to anticholinergic, I might talk about beta agonists versus procedures.

If they're on a beta agonist, if they're on merbegron, I might talk about gemtessa or minimally invasive procedures.

But after they failed one medication, I broached the subject of procedural intervention along with other medications.

And I know we didn't mention it, but I also use a fair amount of vaginal estrogen in the peri- and postmenopausal women.

I find that can also be helpful.