Dear Insurance Company

Apr 18 2011 Published by under [Medicine&Pharma]

A long-term patient recently moved to your state. Establishing medical care with a new specialty practice can take time, so I sent brand-new written prescriptions for all of the drugs the patient required.

The patient attempted to fill these medications. You have been kind enough to reject them pending me faxing back a form to make sure all cheaper alternatives have been given adequate trials. The kid has been on these drugs for four years. FOUR YEARS! The only reason he seems new to you is the move to another state. Now he will miss medications because I have been out of town, and your form is sitting in my office inbox gathering dust.

Could they have been filled for a week while awaiting the form? Could you notify newly covered patients that new prescriptions may take two weeks to fill because of your cost-saving tools? Could you come up with something that allows patients to continue their medications? Could you develop something that does not piss everybody off?

Pascale H Lane, MD

- Posted using BlogPress from my iPad

4 responses so far

  • Melissa G says:

    I live in fear of something like this happening to me or my family.

  • Chris says:

    Uh-uh! Bureaucracy sucks. And I never got why state lines were such a big deal. Hope the kid's okay.

  • brooksPhD says:

    This just happened to me. Went to the store to pick up my prescription and they found out BXBS had rejected it because they disagreed with the my MDs Rx for me. She said 150mg 2x day, company said no, 300mg 1x day is cheaper.

    Fucking assholes -heaven forbid my personal physician should know the best standard of care for me.

  • becca says:

    @brooksPhD it's funny that was the specific case. NPR just did a story on the costs of various drugs. The example they used was someone who was getting an extended release form that you only had to take once a day that was on label instead of a *much* cheaper generic formulation that had to be taken twice a day. The inverse of your company.

    To be perfectly honest, when *neither* the patient *nor* the doctor knows the actual cost of the drugs (because it's negotiated specifically with each insurance company and it's not at all easy to find the actual costs), *nobody* is properly equipped to know the most *efficient* standard of care (including both medical and economic concerns). End result: insurance companies that charge you more than they need to to satisfy the gaping maw of pharma that has to answer to stockholders OR shenanigans like this where there's a very good chance a SANE insurance company and patient and doctor could come up with a good solution that did NOT involve a script being refused.
    This is particularly maddening when the drug is something like birth control. There are a million forms of birth control, and any number of them might be good bets for any individual patient. It would be logical to 1) eliminate ones that may be problematic and then 2) choose the cheapest one. But that is remarkably hard to do.

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