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Getting a Prescription Refill: Hassles from My Health Plan
Val Jones | November 27, 2012
In a recent post entitled “The Joys of Health Insurance Bureaucracy” I described how it took me (a physician) over three months to get one common prescription filled through my new health insurance plan. Of note, I have still been unable to enroll in the prescription refill mail order service that saves my insurer money and (ostensibly) enhances my convenience. The prescription benefits manager (PBM) has lost three of my physician’s prescriptions sent to them by fax, and, as a next step, has emailed me instructions to complete an online form so that they have permission to contact my physician directly (to confirm the year’s refills). Unfortunately, page one of the form requires you to fill in your drug name and match it to their database’s list before you can continue to page two. For reasons I can’t understand, my common drug is not in their database. Therefore, I am unable to comply with my insurer’s wish that I enroll in mail order prescription refills. This will further delay receipt of my medication – and probably increase my cost – as I will be penalized for not opting into the “preferred” mail order refill process.
Now, all of this is infuriating enough on its own, but the larger concern that I have is this: How many patients are not “compliant” with their medication regimen because of problems/delays with their health insurer or PBM? Physicians are being held accountable for their patients’ medication compliance rates, even receiving lower compensation for patients who don’t reach certain goals. This is called “pay-for-performance” and it’s meant to incentivize physicians to be more aggressive with patient follow up so that people stay healthier. But all the follow up in the world isn’t going to get patient X to take their medicine each day if their health insurer or PBM makes it impossible for them to get it in the first place. And shouldn’t there be consequences for such excessive red tape? Who is holding the insurers and PBMs accountable for their inefficiencies that prevent patients from getting their medicines in a timely manner?
Pay-for-performance assumes that physicians are the only health care influencers in the patient compliance cycle. I’ve learned that we only play a part in helping people stay on the best path for their health. Other key players can derail our best intentions, and it’s high time that we look at the poor performance of health insurers and PBMs as they often block (with intentional bureaucracy) our patients from getting the medicine they need. While insurers save money by having patients struggle to get their prescriptions filled, doctors are payed less when patients don’t take their medicines.
Not a great time to be a doctor or a patient…or both.
More Blog Posts by Val Jones
Val Jones, M.D., is a Board Certified rehabilitation medicine specialist licensed to practice in 6 states (NY, CA, DC, MD, SC and VA). She is a 2001 graduate of Columbia University College of Physicians and Surgeons, and the CEO of Better Health, LLC, a medical blogging network. For more of Val Jones’ posts visit Better Health or follow her on Twitter @drval. This post was recently covered by the Heart Sisters blog but originally appeared on Better Health.
Comments on this post
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April 24, 2013 at 11:35 AM
Over the years, I have come to realize that refilling a prescription is more of a hassle than buying a new car. Some times, when my Diovan HCT (hypertension) prescription expires and I need to refill it, my local CVS Pharmacy makes me feel like some pill popping crook. I kid you not! To top it all off, with all the technology that's out there, my local CVS Pharmacy can't even get it together enough to remind me that my prescription is about to expire and that I should schedule an appointment with my doctor to have it renewed.
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