Saturday, September 5, 2009

The Bureaucrats in my Pharmacy

One of the biggest problems with the current health care debate, especially at the 'town hall' level, is that people can't discuss REFORM in an intelligent fashion because they don't understand how the system works right NOW. This was demonstrated early on by the people on Uncle Sam's Medicare who nevertheless are screaming against government-run health care.

The idea of "No bureaucrats standing between me and my doctor" gives all us pharmacists a chuckle because we spend a large portion of our time trying to dance around insurance company rules, restrictions and formularies when trying to fill prescriptions. I can only imagine what it's like on the doctor's side of things with treatments, procedures, diagnostic tests, etc. but I'm sure it is similar.

So I am dispensing a 3-week prescription for Cefuroxime. This is an expensive prescription, costing hundreds of dollars. In talking to the customer, I learn that it is for possible Lyme disease -- he says they're not 'sure' if he has a bug bite, but they're 'not going to take any chances and just treat for it.'

Well, sounds a little thin to me, especially with a drug this expensive, but OK. Now surprisingly, the guy has a reasonable co-pay, but what if his copay was really high and he balked? And if I called the doctor and got it changed to doxycycline (far less expensive but still totally effective)? And keep in mind we don't even know if he's got Lyme disease. So is it bureaucratic interference that the doctor had to change his prescription because of the insurance company's high copay to the patient? Well, I don't think so. It is an effort to contain costs. We have two drugs that will do the same thing, one expensive and one not, so we are going to use the cheaper one first. Pharmacists see this ALL THE TIME.

People want lower costs, lower premiums and lower copays. But there's a certain contingent who don't want that to interfere with their God-given Consitutional rights to get whatever they want. Guess what? --- the only people who get whatever they want are the ones who pay straight-up cold, hard cash or whose insurance plan covers EVERYTHING. I don't think there are too many of those people, though.

I am not sticking up for the insurance industry. When they don't have to pay hundreds of dollars for cefuroxime they should pass that savings on to somebody. I just don't think people realize this is the way it works NOW. Your insurance doesn't cover a drug, so we call the doctor and 95% of the time he changes the prescription to something else in the same drug class, that is covered on the insurance formulary, and does the same thing. Obama tried to touch on this in his "red pill, blue pill" analogy, but you can sense the skepticism --- people get the impression this is some sort of rationing, or substandard care.

Is there a parallel universe I don't know about that doesn't have bureaucrats? I guess people believe that government bureaucrats (with their reputation for waste and inefficiency) are worse than private-insurance bureaucrats (whose goal is making a profit and finding a way to NOT pay your claim). Is that it?

It seems to me it's just a given. There's ALWAYS someone standing between me and my doctor. That would be whoever is paying the bill.


Phathead said...

I have learned to stay away from debates regarding this issue. Too often I deal with people who are up in arms over the fact they are trying to change the health care system. They think there is nothing wrong with it and it's just the governments way of trying to turn us into a communist state.

My rebuttal is always to go ask someone in the health care field. Anyone with a decent sized head on their shoulders knows the system is fucked up hardcore. Every once in a while someone will come back and go 'Wow you were right'.

People just do not have the brain pans to comprehend this kind of thing. I think people are too lazy to actually sit down and do the research on the situation on their own. And if they do, they get their data from some left-wing nut website. Since its on there and not from the government it's gotta be true!

I'm beginning to find the people in this country more and more disgusting.

Grumpy, M.D. said...

Excellent post. Solid points, and well-written.

Anonymous said...

Excellent post. Most of the public has no idea how the system works. Insurance companies determine which provider is seen, what procedures are performed, and which medications will be covered. Whoever pays the bill determines access.

Cody said...

This is why I want to both laugh and cry every time these "death panels" are brought up. What do they think insurance companies can and will do when a patient is too expensive to treat any longer? DROP THEM.

tinfoil hattie said...

Great post. Pharmacists have WAY more accurate knowledge about which drugs are effective than do most doctors. Often, doctors are prescribing the "latest and greatest" drug that the Big Pharma rep has brought in.

Pharmacists are always my go-to people for questions about meds. My mother the nurse taught me that trick: verify with the pharmacist.

THANK YOU for the job you do.

Anonymous said...

Expensive prescription? Thank god I'm living in Switzerland: 14 tablets of cefuroxime 500mg cost CHF 45,-