The scenario: A young woman, a member of a large immigrant population in our city and on state assistance, brings a prescription to the counter. It is from a prescriber who staffs what is commonly known as "urgent care" or "quick clinic" or by many other names -- a walk-in, no-appointment- needed type of area which is intended to address problems that are acute, or can't wait for a regular doctor's appointment. Her prescription: Differin Gel (its generic form) -- a topical acne medication. It costs over $200 for a 1- 1/2 ounce tube. Her out of pocket copayment: Zero. She collected the medication, picked her smartphone up off the counter, and was on her way.
Now, I know this is a sensitive topic. I'm not suggesting that immigrant populations, or those on state assistance, don't deserve quality medical care. Of course they do. But does this qualify?
This nagged at me in so many ways. Why is an "urgent care" provider seeing people for acne? (Don't get me wrong, half the stuff coming out of Urgent Care is not urgent). Do they know that they have selected a $200 medication? Should it be covered under a state plan when many private insurance plans don't, or at least require prior authorization?
The fact that health care legislation is always in the news now makes me more aware of this stuff. I don't pretend to be an expert on all of it, but I can look at the prescription side of things and see a lot of things that don't make sense. People sound alarm bells about the 'rationing' of health care. We all know that it's already rationed. Maybe there are some situations where even more "rational" rationing is not a bad thing at all.
Incidentally, I do know that the huge amount of time we spend processing, labeling and verifying over-the-counter medications for state plans is ridiculous. Forget the computer entry, the labeling, the piles of stuff to check, the impatient insistence and shouts of "Is it READY YET???" Let me hand the customer a bottle of Tylenol, tell them how many to take, and bill the state for one "over-the-counter" charge or some such thing.
No waiting, no labeling, no screwing around.
Lately I am seriously questioning how long we can sustain this.
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11 comments:
I agree with everything you said. Well written post and spot-on.
The one of the pharmacies I use to work at had a large amount of people on state assistance and most would throw a hissy-fit because they would bring in scripts for their entire family for tylenol, motrin, ect and just want us to hand them a bottle off the counter of the brand and let them walk out with it. The state I was in only seemed to cover sunmark brand so we had to special order the stuff in from our wholesaler, it got to the point we kept like 6 bottles on hand because people didn't want to wait for the next day for the script to be ready. I also had someone come in for a brand allergy eye drops that cost like $300 and needed to be ordered if it was covered. After running the claim, the state medicaid denied stating needed a prior auth. The customer was not happy that we did not have it in stock to just give to him and that the insurance would not cover it without a PA and an ER doc is not going to do a PA. The customer had no primary care so we couldn't end up faxing even them for the PA. All I got for spending all that time helping him with his insurance (which meant calling to get the correct ID # because they changed the ID's on all the cards) and working explaining about PA's and he could try an OTC med instead was a complaint to our DM who gave him a gift card for his troubles even though we did nothing wrong.
One of the rationals for state assistance programs covering otcs is that they are so much cheaper. Imagine if the differin patient came in with a script for otc 5% benzoyl peroxide. Had you not seen the differin rx you may have lumped this in with the otc tylenol which almost seems frivolous. However, the patient is still getting care, it is not costing the state nearly anything at all, and you fill another rx. I see these otcs as a win, win, win for all involved. I do like the otc fee idea, though. As long as we can book it as an rx, great time saving idea.
I'm a UK pharmacist. I've just looked up the basic price of Differin gel in the British National Formulary as $200 seemed rather high. In the UK, a 45g tube of adapalene 0.1% gel costs £11.40. Thats $17.81! How come you're having to buy it in for so much more?
I'm a UK pharmacist. I've just looked up the cost of Differin (Adapalene 0.1%) gel in the British National Formulary as $200 seemed rather a lot. The basic price is £11.40, which is about $17.81. Add tax of 20% and then add on 50% for overheads and a profit margin (a fairly standard way of doing a private (i.e. non-NHS) prescription, and that comes to $32.06. Do you have to buy it in for a lot more?
I think she should have been instructed to try Stridex and Clearisil first! I pay for insurance and that stuff is not covered.
There's also the problem that drug companies openly charge more in the US than in other countries because the US lacks the price caps and bargaining powers that other countries use-- Medicare and Medicaid, for example, are legally *prohibited* from using their bulk buying power to bargain for better prices. They say they need to do that in the US because it has to cover all the other countries that make them charge so low they can't make a profit or cover R&D... when the biggest part of their budget is direct-to-consumer marketing that's only legal in the US. If Medicare and Medicaid could bargain I think the Differin gel wouldn't cost so much in the first place...
Yes, it's my understanding that the U.S. subsidizes drug prices for the rest of the world.
Had a state plan pay for Denavir cream the other day. I think it was the first time I've ever seen that stuff covered.
One might think that universal health care plans would take care of outrageous scumbagging by US drug companies. Heck, I thought drug prices on Medicaid formularies (funding by States) were based on the lowest contract price from manufacturers like the VA? Is that not so? If it is not, then no wonder there are so many kickbacks and so much fraud.
asked three differnt pharmacists for advice on how my 78 year old mother can remember to take her twice a day pills. One told me to put a psti=note on the medicine cabinet and the other two told me to call and reminder her twice a day. We live in the 21st century and there has to be something better. My nieghbor, who is a LPN told me about lifesavingpillbox.com. It is a electronic programmable pill dispeser that makes mistakes impossibel. Cost less than 60 dollars (1/2 the price of on script) and she hasn't missed a pill in eight months.
I wish I has been told about this sooner, as it would have prevented tow ER trips.
As a provider writing the prescription, I often have no idea at all how much a medication costs. I'm not sure how I would have access to the cost information without calling a pharmacist and asking; however, I feel your time (and mine) is more valuable than that. I have had pharmacists call to inform me that X medication is too expensive for a patient. Usually, I nearly fall out of my chair at the price tag, and then we work something out to help the patient. I do know that I won't be writing Differin gel again for a state assistant patient just because it's on the formulary (yes, I had the patient try Stridex, benzoyl peroxide, minocycline, etc before writing a Differin prescription). It would be nice if we were able to work together with the patient so we could all be on the same page, benefit the patient, and reduce the cost of healthcare. I guess that'll happen when I'm prescribing tincture of unicorn tears, haha. Oh, and P.S. what's up with doxycycline being so astronomically expensive all the sudden?? I couldn't get that approved for a state assistance patient with MRSA, presumably due to its cost. Local Pharmacy told me a 500 count bottle used to cost them about $20 and now costs them over $1000 (yes,thousand). WTH...
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