November 23, 2016

Insurance Companies Now Writing Prescriptions

Don't believe this? Just wait until you receive a prescription for one medication that you and your doctor have agreed would be the best for your medical condition and you present it to your pharmacist. While you are waiting or when you return, the pharmacist tells you that your insurance no longer will cover your prescription and will only cover another medication.

Hypertension medications are a common problem. The doctor feels that because your blood pressure (BP) is quite elevated, you should be using an angiotensin receptor blocker (ARB) to control your BP and sends this to the pharmacy. However, when you arrive at the pharmacy, the pharmacist tells you that there may be a change and until the doctor replies, your prescription cannot be filled. The pharmacist tells you the your insurance will not cover the medication prescribed and the doctor is calling the insurance company as the medication the insurance will cover may require you to use a pacemaker as it lowers your heart rate to a lower rate than you may be able to handle. These decisions are made solely based on cost considerations and not sound medicine. Yet, this is what happens every day in most medical practices in the United States.

In our current health care system, doctors should get to decide what medication is prescribed. Typically, the patient and doctor decide what is the best, then the prescription is sent to the pharmacy. When the patient goes to pick up the prescription, often they find a different one instead or are told that their health insurance coverage is not covering that prescription. Instead of receiving the best medication for themselves, they are often told to just take this medicine instead. Insurance formularies have gone mad and not in a good way.

Insurance companies will tell you that they send copies to physicians and patients on an annual basis. However, those formularies change and those lists are not always kept up-to-date. Even when we chose a medication that may be listed on a formulary, there is no guarantee that it will actually be covered when a patient goes to the pharmacy. The pharmacist then usually calls to ask to change to a different medication based on the patient’s insurance coverage. I know many people get mad at the pharmacist, but this is not his/her fault — it is entirely on the insurance plan. And patients sometimes get angry with their doctor as well, but the doctor does not possess a magic wand that will make the insurance company pay for whatever medication we wish.

While no one can argue that health care spending in our country has gotten out of hand, there is need to curb those costs in the right fashion. Putting patients in danger to cut costs is not the answer. Insurance company representatives who never received any medical training should never make medical decisions. It is time to end this formulary madness.

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