Mrs. Seegarp: "My headaches have been terrible the last few months, and I don't know why."
Dr. Grumpy: "Have you had more stress? Or does it seem the Perflukin has stopped working?"
Mrs. Seegarp: "I stopped Perflukin 3 months ago when the copay coupon expired."
If you started your appointments with the question "are you still taking XYZ that I prescribed?" your appointment would probably be much shorter.
ReplyDeleteHeadaches start in the wallet.
ReplyDeleteObviously, it's because Pisces has been ascendant.
ReplyDeleteOnce again Dr Grumpy tells us Europeans more about how the US heath care system works than any number of editorials in NEJM or The NYT. Absolutely no criticism intended. Different horses for different courses…
ReplyDeleteI'm going to guess Perflukin is one of the new CGRP drugs, which are roughly $900-$1000 per month. So if you don't have a manufacturer's copay coupon to help offset the costs, too bad. Health care is for the wealthy.
ReplyDeleteFor that matter, you can look at Vyndamax or Vyndaqel. Both are effective at treating a fatal disease - amyloid cardiomyopathy - for the cost of $20,000 to $30,000 per month. Patients get to decide if they want to take a life-saving medication, or eat, or have a roof over them.
Very pithy commentary, as well as anecdote. However, for the PBMs, they'll ask for whether you've accommodated their stepwise algorithm before covering the drug. Sometimes they'll request documentation.
ReplyDeleteIt's actually a freakin' interference in the practice of medicine, and I wonder if anyone will ever sue them for practicing without a license. No. There, I answered the question for myself.
Call up any drug insurance company; they get away with running interference. They don't tell you the location of their original license to prescribe medications so there's no one to complain to directly. Their main interest, no matter how or what they say, is the due diligence to the stockholders.
Sour grapes, much? Yes, these middlemen work like drug reps. Some reputable companies hire reps who graduated in a field related to the product they're attempting to promote, if they actually graduated high school. At least I knew one pharmacist that worked as a rep for the company that makes Epo, but I've never heard of any other pharmacists repping. I mean, we do have a Pharmacists' Oath, spelling out the duty and priorities.
Yes. I did work for the VA and yes, I didn't have to have my license in hand for the State that I was employed, but ... . The point is that is only one of their bottomless bag of loopholes and dodge'ems. No one is morally responsible.
Note how long it took to get some recompense out of Sackler & Co. (However, I don't hold Shkreli entirely to blame for the pickle he is in because he's only playing the game to the limits. Someone wasn't getting their share of the pie is why he was nabbed. Heck. Pharmaceutical companies don't need scientists behind their endeavors. Martin just juggled the money for the speculators, and that's what the company required to do business under USA rules.)
It's the same game phone answerer types can play; 'dodge the pharmacist' when we call the insurance company for our incapacitated hospital patient and request prescription drug histories, and they counter-demand that we have this or that something before we can talk with the registered healthcare provider. "Just let me talk with the pharmacist. I don't know where you are but pharmacists are healthcare providers, and we can talk with each other, in the interest of OUR patient. Now, PLEASE, transfer me to the pharmacist."