In Connecticut, as pharmacy students (at UConn) were they analyzing patient profiles online and then sending the information back to the state for distribution to senior citizens. The students were paid $4 for each profile completed.
This appears to have been an effort to assist people in choosing a Medicare D(isaster) plan that would best meet their needs. Well meaning, yes, but, it is possible that some very important information was not disclosed.
more below
A report released by Henry Waxman details the hidden restrictions that Medicare D(isaster) plans place on those who have chosen a policy.
- Prior authorization requirements, step-therapy provisions, and volume limits by the vast majority of Medicare drug plans restrict access to formulary drugs. The Medicare data show that 97% of plans place either prior authorization or step therapy requirements on at least one of the 100 most popular drugs, with the average plan restricting access to over 10% of the popular drugs listed in its formulary.
- Medicare drug plans are unable to describe plan restrictions accurately. Over two-thirds of the Medicare drug plans contacted in the phone survey were unable to describe accurately how the prior approval, step therapy, or volume limits worked with their particular plan.
- Medicare drug plans provide erroneous or conflicting information about restrictions. A number of Medicare drug plans provided information that was erroneous or misleading or conflicted with other information provided by the plan in the phone survey.
- The Medicare website and the websites of plan sponsors fail to provide adequate information about restrictions.
Despite this, the latest numbers reported claim that 1.9 million people have signed up for a Medicare D(isaster) plan in the last month alone. At first glance, that number appears impressive, however, a this may be questionable. As written earlier, some who are dual-eligilble have switched from one plan to another, as all of their rx’s weren’t covered. Despite this, some of those who switched are still being counted as being carried in both Medicare D(isaster) plans.
some people who are “dual eligible” are now enrolled in two insurance plans. Shirley D. Beer, of Pennsylvania, has found herself in that very situation. After being assigned to a Medicare D(isaster) plan that did not cover all 12 vof her rx’s, she chose a different plan, as it covered more rx’s than the one that she was assigned to.
However, she is still being covered under the first plan, that pays for some of her rx’s although she notified the carrier that she wanted to switch to a plan that covered more of her rx’s.
Guess that the Medicare Rx Bus staffed with “counselors” and their pc’s can’t afford the gas to make it from Boston to Connecticut.
available at MLW and in orange
It is very profitable for insurance companies though.
For those who don’t know, here is how step therapy works:
You feel ill, and go to the doctor. She says, I think you have higollikumkumflips, and writes you a prescription for Pillavil, with instructions to begin taking it immediately.
You go to the drugstore, and wait. When your name is finally called, they tell you that your insurance company will not pay for Pillavil.
You call your doctor and tell her you can’t get the Pillavil. She calls the insurance company and they tell her that first you must take an over the counter medication for a month, and if that doesn’t work, then they will pay for Capsulium, and if that doesn’t work after a month, THEN they will pay for the Pillivil.
So this is two months that your disease is essentially not being treated, unless by some miracle you are cured by either the over the counter medication or the Capsulium.
While doctors do sometimes prescribe the latest and most costly drug as a favor to their pal the pharm company rep who gives them gifts and sweetmeats, all doctors do not always do this, and assuming you have an ethical doctor, if she prescribed Pillivil it is because she knows that it cures higollikumkumflips, whereas the “step” medications do not.
Nobody knows how many people die during their “step” time, which is determined by the insurance company, not the doctor. So if after a week of your over the counter step, you find that your condition is worsening, the best you can hope for is that after spending an afternoon or so on the phone with the insurance company, they will agree to let you skip the rest of that step and go on to Capsulium.
In some cases, if the doctor’s office can afford even more time on the phone with the insurance company, they may be able to talk them into saving your life by just agreeing to pay for the Pillivil, and of course, by this time, if you have any money at all, you will have just bought it from your own pocket.
Prior authorization frequently requires “steps,” and at the very least will require that somebody in your doctor’s office spend a day or two on the phone with the insurance company.
For this reason, some doctors will not even try to do prior authorizations, they will just prescribe the one the insurance company will pay for and wish you luck.
The bottom line, your life and health, the preservation of which should be the primary consideration when prescribing medication, is not.
Thanks, DTF! You worded that much better than I could have. Ironically, when I had pneumonia, I had to go thru step therapy–probably why I relapsed so much. The insurance company paid for my intial anti-biotics, the second, my doctor had to get a prior-auth for, and the third time, my doctor sampled me. (And the samples worked, thank God!)
The bottom line, your life and health, the preservation of which should be the primary consideration when prescribing medication, is not.
And you nailed it! I know how sick I was. And the number of the deaths due to step therapy will never be known. Another reason for a single-payer system. But, the thing is prior-auths, pre-existing conditions, and all of that other crap have to be eliminated. Don’t anticipate good luck w/the insurance/rx carriers/lobbies (the way the $$ floats around) with that, but I am trying to be optomistic.
Should clarify that one–insurance would only pay for the cheapest anti-biotics possible…and they didn’t work. And, the ones that I received samples of went for around $20.00 a piece!!! For 7 pills–$20.00 each. $140.00 for a full supply if you have no insurance. That is insane!
instead of a service, a commercial product instead of a basic human right, the patient will come last on the list.
And here’s what is so stupid–there were actually more of the cheaper pills–generics. (I swear, generics are the biggest rip-off, but that is another subject.)
But $20.00 a pill–because it had a patent on it? That is crazy!
Like you have said, health care is a human right. But, the profits of the rx/insurance industries come ahead of the patients. Even doctors are getting sick of that. Most would rather practice medicine than deal with paperwork. (At least, that has been my experience.)
We need a single payer system–this is bullshit!
they or their staff spend on the phone with the insurance companies means time and money that is not going into anything to do with actual patient care.
It takes five minutes, tops, for the aide to call in your prescription to your pharmacy, after which she can arrange your appointment with a specialist, check to see what’s holding up your bloodwork at the lab, reassure old Mrs Choi that BluPill does make one crave guava jam, and that it’s nothing to worry about, and a dozen other things.
Or she can put off all that until tomorrow or the next day, and spend all that time with your insurance company.
Or the doctor can hire another aide, and cut down the time he spends with patients from seven minutes a head to three so he can have enough money to pay his malpractice insurance, even though your family members will also name the insurance company as a responsible party when the Capsilium doesn’t do it, and you die waiting for your step therapy waiting period and authorization for the medication indicated for your condition.
You are right about the length of time, that is. And the staffing. I’ve heard my doctor rant about it!
http://tinyurl.com/kzg95 Here’s another article Kid that freaked me out a bit saying that starting April 1 when people go to get their prescriptions filled they might have all kinds of problems(hahahaha..no problems before of course)because it seems that the insurance companies were supposedly told to ok any meds needed for the first 3 months but can now start denying certain drugs.
I know it seems that way already but if the insurers are now going to get even more picky what the fuck is going to happen? I really do wonder just how many people have died due to this clusterfuck program.
So people are going to be deprived of their rx’s again? If I have a problem, I’m taking a page of out Frank Cartalino’s book!
If you have trouble, do the same!
If there is trouble, maybe I’ll even blog it too!