Prescription Medications and Insurance Company Oversight Plans

From the perspective of a practicing physician, patient and consumer; the free pass Congress has given the pharmaceutical and insurance industries in health care reform drives me crazy. Yes I heard about the voluntary relinquishing of 80 million dollars by the industry. That makes about as big a dent in their bottom line as me urinating in the Atlantic Ocean and trying to raise the tide.

It is unclear why prescription medications are so much cheaper in Canada and Mexico and overseas?  What is even more unclear is where all of our prescription medications are being manufactured and how do our domestic standards actually compare to products sold across the border?   You never see Consumer Reports do a review article on the quality and safety of prescription drugs produced outside the Continental USA and the locally produced products?   You never see a cost analysis of producing these meds here and abroad.  Yes, you see plenty of articles on vitamins, minerals and herbal products but absolutely no credible studies on their efficacy and safety either.

If I have a major beef as a physician and consumer it’s with the firms health insurance companies hire to oversee their prescription drug plans. The insurance companies know well that most of their patients get their health and insurance and drug plans through their place of employment. They additionally know that most years the plan changes as does the patients general medical doctor.  You see a new patient who is  obese, hypertensive individual with high cholesterol and prescribe them a cholesterol lowering medication only to receive a fax from the prescription drug plan over-site company asking you if the patient has failed on the generic lovastatin and or pravastatin?   They will not prescribe the drug you prescribed, even if it is on the formulary, without first checking that data. Of course you don’t have that data. You know the patient has had five different PCPs in five different years. You may know that the patient had some muscle aches on simvastatin.  The insurance companies don’t care. They know that each time they throw an obstacle in the prescription process; the patient will reach into their pocket book 70% of the time, or more frequently, and pay for the drug themselves rather than wait for the review process.

Even quantities prescribed are an issue. The plans only dole out one months supply. Last month a patient of mine went on a midweek vacation about a two hours drive from home. Her life had been dramatically improved by the addition of Effexor XR for obsessive compulsive problems years before.  The drug helped greatly but if you miss a pill or two it produces a nasty withdrawal syndrome.   The patient, by mistake left her pill bottle at home. She called her pharmacist and asked if he could prescribe some of the medication for her at the local pharmaceutical chain outlet which was close to her hotel. He called me for permission and I approved. The problem was that the drug plan over-site firm had already prescribed a thirty day supply and would not approve the prescription.   How ridiculous. The patient paid for five additional pills at full price just to avoid the hassle.

It’s time for State Legislatures and State Insurance Commissions to put their foot down and start tightly regulating the insurers and the drug review companies. It’s clear our elected Congressional officials don’t have the backbone to do what is right for their constituents in the face of attractive campaign pledges. Thus, it’s time for consumers to act instead.

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