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by throwaway_tech 2333 days ago
In the US, we have something similar (but evil) that people don't know or refuse to acknowledge.

A Doctor writes a script, and then a pharmacist (not on their own, but at the direction of an insurance company) suggests a change typically to benefit the insurer (for example changing a name brand to a generic or changing 30 days to 90 days so the patient doesn't get seen by the doctor again for 90 days for additional testing/monitoring). In the US the pharmacy/pharmacist can not change the script so they send the recommendation to the doctor for approval (and get paid a bonus from the insurer for sending the request), if the doctor approves the pharmacy gets a 2nd bonus, if the doctor does not make the change, there is a very good chance the insurer will drop the doctor from their network for not doing what the insurer asks to lower their costs through the pharmacy proxy.
2 comments
chimeracoder 2333 days ago
> for example changing a name brand to a generic

In most states, the law explicitly requires the pharmacist to fill a prescription with a generic (if available) unless the doctor specifically writes "dispense as written". Not allows - requires.

The purpose of these laws is to protect patients - in the overwhelming majority of cases, the generic and brand name drugs are equivalent for patients, so patients save money by purchasing the generic medication even if the physician prescribed the drug using its more well-known name (the brand name).

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throwaway_tech 2333 days ago
>The purpose of these laws is to protect patients

Its not the patients that lobbies for these laws...it is the insurers, and its to lower their costs.

Its also why the insurers pay the pharmacists a bonus for these changes, if it was about costs to the patient, the bonuses (money back) would go to the patient.

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chimeracoder 2333 days ago
> Its not the patients that lobbies for these laws...it is the insurers, and its to lower their costs.

I mean, no, patients don't lobby for them because patients don't really lobby en masse for healthcare policy in general, but patients definitely are the ones who benefit from them.

There are some cases where the relationship between insurers and patients is adversarial. This is not one of them.

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xtian 2333 days ago
> because patients don't really lobby en masse for healthcare policy in general

See Medicare for All.

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throwaway_tech 2333 days ago
>There are some cases where the relationship between insurers and patients is adversarial.

Well imagine your doctor gives you a Rx, you go to fill and the insurer tells the pharmacist to ask doctor to change it. If the doctor disagrees (for whatever reason) the insurer may drop your doctor from their network, then you will be stuck going to a doctor who does whatever the insurer asks.

If you feel there is no conflict there or that isn't adversarial that is fine...in my experience both patients who lose their doctor and the doctors themselves disagree.

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ars 2333 days ago
That's not something similar, and has nothing whatsoever to do with what you replied to.

And there's nothing wrong with switching from brand name to generic, and most patients don't need to see their doctor every 30 days, and if they do, they can still make an appointment.

The length of the drug prescription does not control the appointment - and anyway you can just call and they'll extend the prescription on the phone.

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throwaway_tech 2333 days ago
>And there's nothing wrong with switching from brand name to generic, and most patients don't need to see their doctor every 30 days, and if they do, they can still make an appointment.

For patients with chronic conditions if the doctor determines the patient should be seen to evaluate their condition in 30 days before a new script is written, insurers having pharmacists effect a change to 90, is a direct interference with the doctor's practice of medicine. The doctor should make the determination, because they have the relationship with the patient, they know if they are at risk or likely to adhere to the therapies better than an insurer making broad brush strokes based on the cost to insurers. You also skip over the part where doctors get dropped from the insurers network when they don't accept the insurers "recommendations."

>The length of the drug prescription does not control the appointment - and anyway you can just call and they'll extend the prescription on the phone.

Sure, but that is not how it works in practice, the patients won't set up another appointment until they need another script, which is cheaper for the insurer and worse for the patient outcomes. Nevermind the Doctor being in the best position to determine which patients should be seen every 30 or 90 days, the shorter duration and 30 day appointments lead to higher percentages of drug adherence...which is a major issue in the US leading to about 1 million hospitalizations per year.

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fr0sty 2333 days ago
> For patients with chronic conditions if the doctor determines the patient should be seen to evaluate their condition in 30 days before a new script is written

I'm reasonably cynical about lots of things, but I would be absolutely shocked if a pharmacist can give you 90days of pills when handed a 30day (no refills) prescription.

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throwaway_tech 2333 days ago
The don't unilaterally change the Rx and hand it to you...they fax the Dr. a request for change to the therapy (and earn a bonus from the insurer for sending the request for change). If the Doctor authorizes the change, the pharmacy gets a 2nd bonus payment from the insurer.

If the Doctor(s) refuse to make the requested change that data is tracked and eventually the insurer will drop the doctors from their network.

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ars 2333 days ago
If the Dr. wants to see the patient in 30 days then they setup an appointment for that.

I don't understand why you think the length of a prescription controls the appointments. It doesn't, it has nothing whatsoever to do with that.

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throwaway_tech 2333 days ago
>It doesn't, it has nothing whatsoever to do with that

Yes, the patient could pick up the phone and schedule another appointment, or the doctor could call to try to schedule another appointment in the meantime. You are missing the point...in practice those appointments don't get rescheduled.

The Doctors and insurers know this, which is why the Doctor tries to do 30 day scripts for at risk patients so they can be closely monitored, and its why the insurer attempts to change 30 day therapies to 90 day because they know the patient won't schedule an appointment in the meantime and that saves the insurer money.

Anyway its clear you see nothing wrong with an insurer interfering with a doctor's practice of medicine...or the other part you keep glossing over that is the insurer dropping doctors from their networks (i.e. patients losing their doctor) when the doctors don't follow the insurers requests for changes to therapies.

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ars 2333 days ago
> because they know the patient won't schedule an appointment

Such a patient isn't going to correctly take their medication either, 30 days or not.

> the other part you keep glossing over that is the insurer dropping doctors from their networks

Yah, because that's not actually true.

Insurance companies do a lot of bad stuff, but you seem to have invented a whole new class of things that they just don't do.

There is no bonus for 30 day to 90 conversion. There is only a lower co-pay for the member.

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throwaway_tech 2333 days ago
>Such a patient isn't going to correctly take their medication either, 30 days or not.

Exactly that is why the doctor specifically writes a 30 day so they come back in and can check their numbers.

>Insurance companies do a lot of bad stuff, but you seem to have invented a whole new class of things that they just don't do.

When you hear the term consolidation of the healthcare market this is what they are talking about. There are numerous lawsuits right now by doctors against insurers for dropping them, illegally, from their networks and sending their patients to new providers/practices that are owned by the insurers. You can find any number of those lawsuits, if you cared, but here is an article on the practice of insurers buying providers (to control all aspects of their costs), you have insurance A, odds are you are only able to go to a doctor practice/hospital owned by the insurer.

https://www.modernhealthcare.com/article/20180602/NEWS/18060...

>There is no bonus for 30 day to 90 conversion

You are wrong, and it is clear you have never even heard of Medication Therapy Management (MTM) or OutcomesMTM. Walk into any big pharmacy (walmart, cvs, walgreens) and ask the pharmacist about OutcomesMTM and MTM generally. Or use this link to a OutcomesMTM report and learn about it http://www.outcomesmtm.com/wp-content/uploads/2018/02/2016MT...

>"Today, more than half of U.S. pharmacies are active in OutcomesMTM programs, earning revenue for their clinical services while helping healthcare payors reach their goals."

>Each year, OutcomesMTM recognizes pharmacies and pharmacy chain organizations with exceptional performance in delivering MTM services. Top MTM Center and Top Chain awards are based on the organization’s overall effectiveness in delivering CMRs and resolving drug therapy problems through TIPs

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