GinaXOXO wrote:
SOXFAN:
Doctors now have less choice in what they prescribe patients, due to the fact that third party insurance companies actually administer the program
I have a huge question about this. My doctor is now computerized. I take armour thyroid and zyrtek d. Armour is an old medicine that isn’t regularly prescribed anymore and synthroid is now the currently prescribed medicine for people are hypothyroid. Armour is inexpensive because it is no longer under patent. I had done a lot of research and really felt/feel that armour was the best choice for me. I had to change doctors because my doctor wasn’t willing to prescribe it. Zyrtek D is now sold over the counter. Ok there is the background, so I was looking at my Doctors computer and there were red sad faces next to my prescriptions. I asked my Doctor about it and she said it was because they aren’t “insurance friendly” as coded by the insurance companies. I dropped it. I adore my Doctor and didn't want to ask but . . . I have to wonder . . . it is because drug companies aren’t making as much money on armour and zyrtek?? Is this a friendly reminder from the drug companies that they aren't making as much money????
Gina, this can be a confusing issue. What you likely saw on your doctor's computer is what's called a "hard stop". It is a notification that is placed on some prescriptions as a way to reign in costs.
Insurance companies pull their own claims data pretty frequently these days, and they do an analysis on "comparitive drugs" of the same class in terms of dosing and total cost of therapy, per patient. If they find one to be more cost-effective than another, and the efficacy is relatively the same for both, they will put this "hard stop" in place, which is basically telling the pharmacy, if you fill this script, you and your patient will not be reimbursed.
You should also know that these insurance companies also have P&T Committees (pharmacy and therapeutics), where a medical expert or two is always represented. However, understand that if the two treatments are even in the same ballpark with each other in terms of efficacy, the cheaper alternative will become "formulary exclusive" and the more expensive option will be issued this "hard stop" on the computers.
Understand, they will also do the same with generics and OTC products for which you need a prescription. Yes, there are actually a few OTC drugs that would actyually require a script, one being Prilosec (or at least that WAS the case with BC/BS here in CT).
So to answer your question (and I know there are some here who think I am shilling (sp?) for my industry)...No, this is NOT a function of the pharma industry. Most people do not realize how little control the pharma industry actually has over which drugs you get, and which ones you do not get. That is left up to the federal government (for duel eligibles - Medicare/Medicaid, or just Medicaid pts), and to the private insurance companies.
I will also tell you that the federal government gets their drugs for pennies on the dollar. It is law that the FEDS HAVE to get the lowest price in the market. That is why the pharma industry is so scared about universal healthcare. The Fed Gvt will force our companies to negotiate "best price" to everyone, and research and development will be sacraficed. So, if you ever want to see that cure for Diabetes, you'd better root against universal healthcare.
People love to point to Canada's healthcare system as some panacea. But think about it, how many novel therapeutics do the companies in Canada develop in any 10 year period? How many in the US? Most of the great advances in medicine have come from here, though the US pharma/biotech industry. You just can't have it both ways. The only answer is for the pharma companies to do "missionary work", and throw profits out the window. Some here may think that is wonderful, but it is how many of us make a living.
I'll tell you a quick story about these insurance companies...I also call on LTC pharmacies (the omnicare and pharerica's of the world)...I was sitting in a meeting last week with one of my customers, and he was telling me about a patient in one of his skilled nursing facilites that was DENIED their asthma medicine, Advair Diskus. Advair is a combo medicine, combining both a corticosteroid and a beta agonist. This patient, doe to the type of asthma she had, needed both mechanisms of action to effectively treat her asthma (she's 75!). The insurance company told this pharmacy that they could ONLY dispense Flovent to this patient. Flovent is a corticosteroid and does NOT contain a beta agonist. So, because the insurance company denied reimbursement for the Advair, my customers' hands were tied and had to ship the Flovent.
The monthly cost for Advair: $270.00/month
The monthly cost for Flovent: $112.00/month
Any questions as to the motivations of the insurance company? Yet, because the media helps to paint an inaccurate picture, the pharma industry is 'evil'. The pharma industry gives away more free product than any other industry in the world.
Another one...NY Attorney General Andrew Cuomo just wrapped up and investigation of United Health (an insurance company). United was setting reimbursement for out of network visits too low, thus scamming patients out of millions of dollars...The most damning thing here? Ingenix, a company that many payors use to set reimbursement rates, is a subsidiary of United Healthcare. In other words, United was inflating it's own bottom line, through deflating reimbursement rates. A major conflict of interest.
Again, did this make news? Barely. but if it were big pharma scamming people out of millions, you can bet Katie Couric would've been leading off with it, and Chris Matthews would NOT have been getting chills up his legs.
Soxfan:
I am not a racist, a bigot, a douchebag, an anti-semite, etc. I used a metaphor and an outdated term that offended you (that no matter what you say, some people still actually LIKE being called, apparently).
I had to laugh a little at this . . . it is so ridiculous that you have been called any of these names . I don’t know if anyone else will agree but, it is clear to me that you are
none of these things. There in lies the humor.
