Doctors Counseling Patients on Drug Therapies
Does your doctor know the cost of the brand name drugs she prescribes for you? Does she know the cost of generic and therapeutic substitutes? Odds are she doesn’t. As we have pointed out before, helping patients shop for drugs is not something third-party payers pay doctors to do. Fortunately, entrepreneurs are finding a solution to a problem that was created by a dysfunctional third-party payment system.
Walgreens pharmacy and Epocrates, a widely used mobile phone drug information app, allow doctors to check a patient’s drug plan formulary for covered drugs and co-payments as well as prices for brands and lower-cost alternatives. Walgreens stands to gain business by offering a valuable service. Doctors gain by not having to change prescriptions when a patient discovers a drug is not on their formulary. Patients gain by getting their medical needs met for a cheaper price.
This is a really good example of how screwed up the whole system is. Absent stupid regulations, the Minute Clinic nurse, the pharmacist employed at CVS, and perhaps an off-site doctor would enteract and provide optimal drug information to patients for optimal prices. They would all share in the profits of this enterprise.
Doctors get paid by CPT codes. There is no code for providing patients with information about shopping for drugs — as Devon Herrick has pointed out in his many publications.
Thanks to Walmart, patients often ask their doctor for a $4 prescription and just pay for it out of pocket. A recent New England Journal of Medicine commentary laments that without third-party payment, drug stores don’t bother to record the sales of $4 generics, so Big Brother doesn’t know all the drugs patients are on.
It seems like there could be an expanded role for pharmacists in the system to help solve this problem.
You ask any doctor how much they enjoy having to deal with a pharmacist calling to challenge his medical judgement not to substitute a generic for a brand name (most prescription forms already include a special “daw” authorization) but a different compound because some manager knows the profit on that compound is higher.
I think artk makes a fine point.
As an insurance broker, if my client calls me to ask about their formulary coverage I will get that information for him. Most brokers do. The problem is most people don’t ask, they rely on their doctor advice.
Sure Erik, patients should always ask insurance agents about what drugs to take. After all, what do doctors know about a patients needs? This isn’t a generic vs branded issue, this is an issue where an insurance company won’t pay for a particular drug because their financial people have decided that another compound is close enough or good enough.
For those not in the know, “DAW” means “dispense as written,” meaning that the doctor forbids the pharmacist from dispensing the generic equivalent, which the state law might otherwise encourage.
The issue of whether a drugmaker’s detailers (or salesmen) can give doctors prescription pads that are branded comes up sometimes as a policy issue. Usually, these are used for patented drugs so that the doctor will be more likely to prescribe the drug already written on the pad. However, I suppose they are also useful for off-patent drugs if the brand-name drugmaker still wants to keep market share.
Although the health plans don’t pay doctors to help patients “shop for medicines,” I have learned that they will pay doctors to switch their prescriptions from branded to generic. Of course, this entire struggle between health plan and brand-name drugmaker is entirely invisible to the patient, and, therefore, likely results in perverse outcomes.
Artk,
It is a formulary issue. As you should know, a drug can be placed on the formulary list of pateints who’s doctors write a Dispense as Written prescription. There is a process the insurance companies have the patient/doctor complete to have that medication included. That is where a good agent comes in.
As a pharmacist, I would love to help patients navigate cost/copay issues. Unfortunately, the tools to help start at the prescribers (electronic,hopefully) pen.
Prescribers don’t have time to research all the changing formulary tier options before choosing the best RX for any one patient.
At the pharmacy, in any one hour, the same medication and quantity can hit several different copay/coverage tiers. Granted, it’s a comptetive system. It’s also inexplicable.