The other day my receptionist left me a message. I was from a pharmacist who was having trouble reading my handwriting. I attended eight years of Catholic grammar school. My principal was a three hundred pound woman named Sister Catherine. I have impeccable penmanship.
I called the pharmacist who explained she was unable to read the name of the drug. I asked, “Who is the patient?”
“John B.,” she said, “The directions on the script read, 6mg SQ QD.”
I know John B. is HIV positive. “Is it for Serostim (a brand of growth hormone prescribed for HIV associated wasting)?”
“Uh, that could be it.”
“Where are you located?” I asked.
Chelsea happens to be one of the neighborhoods in Manhattan with the largest population of gay men. It was unfathomable that this pharmacist hadn’t filled a prescription for Serostim.
“How long have you been working there?”
“A whole month and not one script for Serostim?” I said. Then I asked, “Which pharmacy do you work for?”
She mentioned one of the large chain drug stores. Enough said.
More and more insurance plans are dictating where patients can fill their prescriptions. This is alarming to me when you consider that these same insurance companies are allowing doctors fewer choices of prescription drugs. For instance, I wrote a patient for Micardis, an antihypertensive medication. His pharmacist informed him that his insurance company wouldn’t cover the cost. His insurance carrier then faxed me a list of meds they would cover.
It’s frightening to think an insurance company, not a healthcare provider, is choosing which medications their patients should take.
This year, more insurance companies are requiring patients to use mail order pharmacies. The rue is that it will be cheaper for the patient. This is true. Mail order pharmacies may be cost-effective. My patient, Billy J. gets his HIV meds via mail order. They send him a 3 month supply. The upside is that he only pays one copay. The down side is that his meds often arrive late. This is alarming for someone with a chronic disease like HIV, when missing a dose can have unwanted consequences like, resistance. I suggested he use a local privately owned pharmacy like, New London.
He said, “My insurance company won’t allow it.”
But this problem goes even further. Insurance carriers should not tell doctors which drugs to prescribe nor should they influence where patients get their prescriptions meds filled.
Case in point: Charlie M. travels around the world for work. He has HIV, Hep C and high blood pressure. His is on a laundry list of meds.
His father had a heart attack one Friday night. Charlie called and asked if I could get him an early refill on his meds because he left them in a hotel in Brazil.
I asked, “Which pharmacy do you use?” I’ll simply say it was a pharmacy attached to a popular drug store chain.
I called them. The pharmacist, of course, did not work there normally. Like most chains, pharmacist fill in and rotate routinely so that they are unfamiliar with their clients. I explained the situation. The pharmacist informed me that he was not authorized to over ride a premature request for medications as expensive as HIV meds. Frustrated, I hung up and called my patient.
“What do I do?” he asked.
“Pay for your medication yourself,” I suggested.
Incidentally, if Charlie was diabetic the pharmacist would not refuse him insulin.
Later that same day I went to New London to fill a prescription for my partner, Chad. I asked the owner if she was aware of this trend to use mail order and large chain pharmacies. She explained they were driving small pharmacies out of business.
It’s sad when you think about it. The glory days of visiting a local pharmacist who knew your name and probably your prescription medications by heart is a thing of the past, like visiting Sam the butcher for you meat or Gepetto, the cobbler for your shoes. Perhaps I’m most bothered by this growing trend because I see it shifting toward doctors. Oh wait, that’s already happening. Insurance carriers prefer you see in-network doctors particularly if you have an HMO.
Be smart, if you have to use mail order, stay on top of your deliveries, and complain to your insurance company if they’re late. If you can’t use a privately owned pharmacy then make sure you learn the name of one of the regular pharmacists and the name of the person you paid at the cash register.