Please Stop the Insanity!

Hey, if anyone has any connections with, or fewer than six degrees of separation from, President Obama, would you PLEASE ask him to take a look at my blogs and see if there’s a chance he’d invite me up to Washington, maybe when it’s a bit warmer, to discuss my ideas on healthcare reform? I want better prescription coverage for patients and less paperwork for doctors. It’s that simple.

I want insurance companies to stop telling doctors how to practice medicine and third-party benefit managers to stop sending me letters telling me that a patient has been on an antidepressant for nine months and that maybe she should stop taking that medication. And I’d like the same benefits manager who sent me a letter to inform me that, based on “medical and pharmacy claims,” one of my patients has not had a follow-up visit for at least seven months, to know that that patient has actually been in the office four times during the past seven months.

And PUHLEEEASE, do away with any prerequisite for writing prescriptions that has the word “step” or “steps” in it. They are time consuming and put our patients at considerable risk.

I recently received a fax from BC/BS describing their “Responsible Steps” program for prior authorization of certain medications. I read the header on the page and was amused to think the fax was generated from an application titled “Faxination.”

At the top of the list were requirements that must be followed when prescribing any of the TZDs (thiazolidinediones) for diabetes. To prescribe Actos, Actosplus Met, Duetact, Avandia, Avandamet, and Avandaryl (as if there are many prescriptions written any more for the latter three), one must first prescribe a sulfonylurea, metformin, or insulin agent (for Actos products) prior to use of a TZD. When TZDs hit the market a few years ago, they were hailed as new treatments for diabetes to preserve pancreatic function and were widely accepted. In the last year, Avandia has come under fire but Actos has been free of any major problems. But where do the “experts” at BC/BC get their information to make insulin usage a prerequisite to using a TZD? It doesn’t make sense to a number of endocrinologists I know either.

And then there’s the following CIGNA chart. It’s “Step Therapy” for using statins and describes what doctors must do before prescribing any brand name of their choice. Would someone please stop the insanity?