I'd like to offer perspective as a health care provider who is looking at financials in the trenches. I am a pharmacist practicing in a specialty pharmacy supporting children's health care. Administration of the benefits currently provided by the government is time-consuming and overwhelming at times.
In Wisconsin, rebates are given to the state from companies who are currently "on contract" or on formulary. The formulary, or list of medications that are covered, changes monthly. In April, Wisconsin Medicaid decided that two generic medications used to treat gastroesophegal reflux disease (GERD) would no longer be covered, but a brand name medication would be. To be proactive and provide better patient care, we contacted each physician prescribing the two older drugs. The physicians had to decide to switch to Aciphex (which is not FDA approved for use in children), or put through what is called "prior authorization" (PA) paperwork to substantiate why that patient required the older therapy. Neither the physicians nor the pharmacists are compensated for this, and the patients who need medication wait. If time is money, then this is a huge indirect cost of health care. When we're doing this, we're not doing our "real jobs".
Why is the state switching patients from generic medications they are stable on to a more expensive brand name? Waste. Formularies switch month to month which is waste resulting in poor patient care. Why is the state requiring the use of a mediation in children which is not FDA approved for use in children? Stupidity or greed (don't forget about that rebate check the state is getting).
The government will not only provide the means for health care, but will be directing health care as it is on a state level now. I don't think we as a society have really considered how this "Obama Care" will be implemented. Physicians will be overwhelmed with these types of requests, and even the most dedicated health care professional will have to lower their standards of care. The first reform we need is the elimination of waste, corruption, and poor judgment in the systems currently in place. Take this one example on this one day, multiply it by 365 days a year and 50 states. Hey, this is only your visit to the pharmacy too! Hope you all have lots of free time to wait around for your affordable health care. I am honestly scared.
Anonymous RPh
Subscribe to:
Post Comments (Atom)
I thought that this particular take on the new health care reform was very interesting. As an outsider, it can be very difficult to know how certain inefficiencies can affect patient care. It is only further proof that our medical system is a bit out of whack and only after the almighty dollar as opposed to actual patient care..
ReplyDeleteSo, from what I am understanding, the state is requiring the switch and dictating the new formularies, right? In your opinion then, who should determine these issues? Insurance companies, the federal government, pharmacies, physicians, patients?
ReplyDeleteThank you for sharing your knowledge on this topic. I had no clue that patients were being given expensive brand name meds over the generic brand or that children were given drugs that were not approved for them.
ReplyDeleteGreat input. You offer a unique perspective to the financing sector of health care. Can't say that I completely agreed with everything you said but it is certainly nice to get both sides of the discussion.
ReplyDeleteThanks for contributing to this class blog; I appreciate the important points you offered in your post. Please feel welcome to comment on any other part of this blog.
ReplyDeleteI feel that many people have not taking into account how the actual quality of care will be affected when this health care bill of Obama's takes into effect. Many of my family members have expressed concern with the level of care that they are going to receive. My family has a high incidence of diabetes so they require many doctor's appointments and they are worried that important problems might be overlooked since physicians will be taking on more patients and decreasing the amount of time they can spend with their patients. Hopefully this health care staffing shortage that we are bound to experience can be figured out.
ReplyDelete