“But….. I’ve been coming here for years!” She was right too, she had been coming to the pharmacy I was working at one day for years. She said it in a pleading way as if I was some judge assigned to rule on a case that would determine where this patient could continue to fill prescriptions there or not. “I’m sorry, there is nothing we can do about it” I said as I gave her the news. A phone call to her insurance plan confirmed that she was no longer allowed to get that medication at our pharmacy.
That patient’s dilemma seems to be an example of a growing trend in the healthcare system. And for patients, this trend means less freedom to choose their own providers and more restrictions being placed on them by their health insurance companies. For proof of this, simply go to your local pharmacy.
The patient from above who told me she had been filling prescriptions at our pharmacy needed an injectable medication. It was a maintenance medication for a chronic condition. But the actual drug or the condition it treats is irrelevant. The bottom line is that after years of getting the injection in question from her local pharmacy, she was now forced to use either what was termed “a specialty pharmacy” or a mail order facility to fill the very same medication. And guess who was behind those walking orders? That’s right, the insurance company was to blame.
I feel bad for patients who have to uproot and move to a new pharmacy simply because of some insurance restriction. I’m sure there are many patients who have Express Scripts insurance who can tell you about not being pleased at having to leave Walgreens at the beginning of this year. I’ve seen plans that only allow a 90-days supply at certain retail pharmacy chains or not at all. And other times patients must use mail order only for certain medications. What ever happened to the patient being free to make the choice of where to fill their prescriptions on their own?
If one needs an example of just how large and powerful the health insurance industry has become, simply look at the number of patients who have been displaced away from a medical provider or pharmacy simply because of their insurance. People are getting more and more maintenance medications through the mail not out of choice, but because their prescription insurance simply won’t pay for their Lipitor or Plavix any other way.
I remember years ago I received a phone call from my primary care doctor’s office. It was late in the fall and the woman on the line told me “we’re very sorry, but as of the first of next year we will not be accepting your health insurance anymore.” She went on to tell me that the insurance I had at the time didn’t pay them anything for their services and that they had to make the difficult decision to drop my plan.
This woman was tentative and very apologetic on the phone as she explained their new policy to me. I bet she had been yelled at more than a few times when she gave a patient this news. As for me, I told her I understood why they had to do what they were doing. I told her I was a pharmacist and I knew how bad things could get for providers trying to get paid for their services. It was inconvenient for me to leave the doctor who knew me and had treated me for years and years, but I understood. These things happen in modern medicine. But why?
But what frustrates me is the fact that the patients always seem to be along for the ride now without any say in where their boat is taking them. Why can’t the decision of which doctor to see or which pharmacy to fill prescriptions at be left to the patient, not their insurance company? Why are there “preferred provider” lists or “network doctors” or however else insurance companies phrase their approved list of providers? Does that just mean those are the providers willing to serve patients and get the paltry reimbursements back that an insurance company was willing to give?
I only ask because from my vantage point, this idea of patient displacement is a growing trend. Patients are having to find new providers and pharmacies all the time now because their old doctor or pharmacy just isn’t on “the list.” I guess I just wonder why it is the insurance company and not the patient who gets to make that list. It doesn’t seem like the patient has any rights anymore.
Patients are already having to deal with rising costs and more restrictions on their healthcare. The least they should be able to do is determine where they can get their medical care themselves instead of having those decisions made for them. If you need any proof of the power and influence of the health insurance industry, go ask one hundred random patients why they shop at the pharmacy they do and see how many of them answer “because that is where my insurance tells me to go!”
It’s a shame that patients don’t have more rights these days. It’s a shame that pharmacies can be shut out from serving a large group of patients simply because their insurance company tells them not to go to a given pharmacy. This trend of patient displacement is happening all over the country because of the influence of the insurance industry. And I’m afraid for patients everywhere, it will only get worse as time goes on.
The Redheaded Pharmacist