tag:blogger.com,1999:blog-7323692122514281455.post8901158445846261915..comments2024-03-18T17:51:23.018-04:00Comments on MD Whistleblower: Pharmacy Benefit Managers vs Physicians: Let the Games Begin!Michael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-7323692122514281455.post-51822866261157510282011-08-12T23:56:19.073-04:002011-08-12T23:56:19.073-04:00I am the mother of a child who had been on Norditr...I am the mother of a child who had been on Norditropin for a year - He finally went from minus three percentile to fourth percentile - during that time we switched from Aetna to a good UHC plan to a relatively poor UHC/Oxford plan<br /><br />He has not had any growth hormone since April when I called for a refill and Prescription Soultions told me Norditropin is not covered and it would be over #2,000 - did I want to refill it? Confused - I thought it was a mistake<br /><br />I called Nordicare, the endocrinologist, Oxford, Medco - First, Medco/Oxford forces me out of Premier Kids Care and into Prescription Solutions (I could think of a few choice names for them none of them specialty pharmacy related)<br /><br />The long and short of it - pharmaceutical companies and insurance are quite a scam - Oxford moves brand names down to Tier 2 and generics to Tier 3 - Have preferred meds so that you are forced to switch, get retrained, -<br /><br />Where can we complain? Where is oversight?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-45021469243631520652011-07-30T16:56:43.688-04:002011-07-30T16:56:43.688-04:00In primary care, add to PPI's...
Quinolones (...In primary care, add to PPI's...<br /><br />Quinolones (if its not ciprofloxacin)<br />ADHD meds (if you want once daily dosing)<br />Statins (if they you need greater reduction than the generics offer)<br />Any albuterol inhaler (since they went CFC-free)<br />Any branded SSRI<br />Don't forget the one off's that require prior auth/step-edit like Singulair or Provigil <br /><br />As for formularies in the EMR... <br />- it comes up on less than half our patients<br />- validity is questionable (lisinopril red?? really??)<br />- even the 'ok' ones sometimes get rejected when there's a step-edit, but the prescriber doesn't know it at point-of-care<br />- formulary only matches when you are starting a new med, refilling is rolling the dice if the patient changed insurers or the insurers formulary changed or if it's been a year since you last jumped through the flaming hoops of prior authorizationAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-18872870161357964232011-07-27T02:02:22.449-04:002011-07-27T02:02:22.449-04:00Excellent Post, thanx for sharing the same.. Will ...Excellent Post, thanx for sharing the same.. Will keep on reading the post.Cervical Cancerhttp://docturs.com/dd/pg/groups/15901/cervical-cancer/noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-84547994559630404272011-07-26T13:24:54.678-04:002011-07-26T13:24:54.678-04:00I am fortunate that my EMR (EPIC) incorporates the...I am fortunate that my EMR (EPIC) incorporates the preferred lists into the pharma database for each patient based on their insurance info, so if that is up to date, then as I am typing in the drug name, the "preferred" drugs are green and others others red. <br /><br />Has probably changed my prescribing habits more than any rep ever did.Margaret Polaneczky, MD (aka TBTAM)https://www.blogger.com/profile/16555722791007332247noreply@blogger.com