For the last decade or so, it has been about the money for me. I get no greater pleasure from my job than saving the patient money. This is especially focused in Texas City, Texas where a twenty dollar bill is a lot of money.
I do my best to keep people of modest means out of the “doughnut hole.” I have suggested that doctor’s change from Lipitor to generic Zocor simply because the patient would go without. I love what we used to call “counter prescribing”, the recommending of OTC products after hearing the symptoms. I always pick out the “house brand.”
I could feel a slow burn on my neck when I read a prescription yesterday. In Texas, the only way for a prescriber to get DAW1 is to actually hand write these words on the face of the prescription: “Brand Necessary or Brand Medically Necessary”.
The Naked Gun 2½: The Smell of Fear hd Yesterday, some Bozo wrote “Brand Necessary” on an Rx for Prozac 20mg, #60,
ii qd. I told the patient that there was a 99% chance that her insurance would not
allow the brand name and that the doctor would not allow the generic.
This poor woman began to cry. She sobbed. She obviously needed the drug but you and I know that Prozac would not cheer her up any better than the generic.
“What can I do?” she wailed. “I don’t have a lot of money.”
“I’ll call the doctor,” I said. That is when it got fun.
“We want the brand name,” a young female voice said. “We made that very clear on the prescription. Why are you calling and bothering us?”
“Her insurance will not pay for Prozac. Period. We have a reject if you want me to fax it to you.”
“I told you that we want the brand.”
“So you want her to pay for this out of her pocket.”
“I guess she will have to.” Flippant. Attitude. She did not give one shit about this woman’s pocket book, but I did.
“Are you the doctor?”
A pause. “No, but I am authorized to call in prescriptions.”
“So, you are a Registered Nurse.”
A longer pause. “No, I am not but I ……”
“….. What professional qualifications do you have?”
A much longer pause. “I … ah … I ….”
“Listen. Here is the deal. 60 Prozac 20mg will cost this woman $349.00. The generic
will cost her around $5.00 in copay. You get that message to the doctor within 10 minutes or I will recommend that he fire you for unconscionable disregard to the patient’s health and welfare.”
Five minutes later, the doctor himself called. “Gee whiz, I had no idea about the price of Prozac. Why won’t her insurance pay?”
“The price,” I said, “These insurers are not stupid. Brand name prescribing in many cases is simply over-utilization of a very fragile medical system.”
“Oh, really.” Right over his head. “Give the generic, I guess.”
How long are we going to put up with allowing people with barely a high school
education to represent doctors?
A classic. A couple decades ago, I asked a girl who called in an Rx,
“Was that Seldane or Feldene?” She said, “Yes!”