The Seasonal Script Shuffle

pillbottleDuring the first few months of every year, everyone is used to dreading the tax season of preparing those wretched returns, but now physicians and other providers of primary care can also look dreadfully forward to the yearly change of the formulary with its compulsory deluge of forms requesting medication changes. What is accomplished with this fruit basket turnover of medications is nothing that usually improves anyone’s health, but solely serves to help the financial bottom line of the insurance companies who send them while they continue to raise yearly premiums and co-pays to levels hardly imaginable. Physicians loathe these forms because little is accomplished that is worth our time and training. We want to improve our patients’ health and get to care for them, not just serve as liaisons to enforce insurance company policies for their own financial benefit. It leaves one feeling thoroughly unfulfilled and used like a pawn.

Requiring us to change within classes of medications, as if all of them are the same chemical compound with just different names, reveals the naivete of the people who are making the decisions for us now. Any physician can give loads of examples. What is worse are the physicians who work for these companies who actually are aware of what they are doing and have pushed aside their conscience for mammon while foisting this charade upon us underlings, the grunts who toil among the patient masses, while they sit in their ivory towers thinking of what their next cost-saving measure, labeled as a quality measure, will be.

In the past, most of this rigmarole was confined to forcing us to choose a generic medication instead of a brand name medication. It was not that difficult to accomplish and most of us were able to go along with it without too much of a problem. Nowadays, however, this has morphed into an out-of-control prior authorization (PA) scheme designed to prevent patient care, not just alter it, while it is done in such a way where the physician can be blamed for the lack of supply of the medication to the patient; we simply do not have the time to complete all of the forms the insurance companies want done. They know that and have learned to keep those road blocks in the way so that they can keep their costs down. The number of these PA requests continues to escalate and take our precious time away from doing what we were trained to do, just to help the insurance companies have a better profit.

In addition to the PA system they have shifted to full tilt, their strategy for more control and more profit has started pushing into full throttle the forced acceptance by patients of mail order pharmacies. Most patients like their local pharmacy and want to continue to use them for their medications because they know them and trust them. Patients are now being forced to pay outrageous prices if they try to use a local pharmacy and it is not the local pharmacies’ choice, but is arranged this way by the insurance companies who now have their own centralized pharmacy chains. If physicians were behaving in this manner, we would be hauled into court on felony charges, but not so for the large insurance companies who can pay for lobbyists and campaign contributions to keep this legal.

How can we fix such broken system? First, if insurance companies want to force medication changes through financial pressure, require them to accept the liability for their decisions if the physician opts to disagree with them. Second, require the insurance companies to pay a fee to physicians to cover the cost of these forms being completed and submitted, which is not reimbursed, and costs us all a lot of payroll expense. If they have to start paying something for this to be done and share in the liability for their decisions, I think they will start thinking twice about continuing this game where they seem to be able to make all of rules as they see fit. Patients and physicians need our leaders to help us reclaim our health care, not help these profit-driven insurance companies take further advantage of us all.

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