3 ms·

In the US, we have something similar (but evil) that people don't know or refuse to acknowledge. A Doctor writes a script, and then a pharmacist (not on their

In the US, we have something similar (but evil) that people don't know or refuse to acknowledge. A Doctor writes a script, and then a pharmacist (not on their own, but at the direction of an insurance company) suggests a change typically to benefit the insurer (for example changing a name brand to a generic or changing 30 days to 90 days so the patient doesn't get seen by the doctor again for 90 days for additional testing/monitoring). In the US the pharmacy/pharmacist can not change the script so they send the recommendation to the doctor for approval (and get paid a bonus from the insurer for sending the request), if the doctor approves the pharmacy gets a 2nd bonus, if the doctor does not make the change, there is a very good chance the insurer will drop the doctor from their network for not doing what the insurer asks to lower their costs through the pharmacy proxy.

chimeracoder 7y ago
> for example changing a name brand to a generic In most states, the law explicitly requires the pharmacist to fill a prescription with a generic (if available) unless the doctor specifically writes "dispense as written". Not allows - requires. The purpose of these laws is to protect patients - in the overwhelming majority of cases, the generic and brand name drugs are equivalent for patients, so patients save money by purchasing the generic medication even if the physician prescribed the drug using its more well-known name (the brand name).
- throwaway_tech 7y ago
  >The purpose of these laws is to protect patients Its not the patients that lobbies for these laws...it is the insurers, and its to lower their costs. Its also why the insurers pay the pharmacists a bonus for these changes, if it was about costs to the patient, the bonuses (money back) would go to the patient.
  - chimeracoder 7y ago
    > Its not the patients that lobbies for these laws...it is the insurers, and its to lower their costs. I mean, no, patients don't lobby for them because patients don't really lobby en masse for healthcare policy in general, but patients definitely are the ones who benefit from them. There are some cases where the relationship between insurers and patients is adversarial. This is not one of them.
    - throwaway_tech 7y ago
      >There are some cases where the relationship between insurers and patients is adversarial. Well imagine your doctor gives you a Rx, you go to fill and the insurer tells the pharmacist to ask doctor to change it. If the doctor disagrees (for whatever reason) the insurer may drop your doctor from their network, then you will be stuck going to a doctor who does whatever the insurer asks. If you feel there is no conflict there or that isn't adversarial that is fine...in my experience both patients who lose their doctor and the doctors themselves disagree.
    - xtian 7y ago
      > because patients don't really lobby en masse for healthcare policy in general See Medicare for All.
ars 7y ago
That's not something similar, and has nothing whatsoever to do with what you replied to. And there's nothing wrong with switching from brand name to generic, and most patients don't need to see their doctor every 30 days, and if they do, they can still make an appointment. The length of the drug prescription does not control the appointment - and anyway you can just call and they'll extend the prescription on the phone.
- throwaway_tech 7y ago
  >And there's nothing wrong with switching from brand name to generic, and most patients don't need to see their doctor every 30 days, and if they do, they can still make an appointment. For patients with chronic conditions if the doctor determines the patient should be seen to evaluate their condition in 30 days before a new script is written, insurers having pharmacists effect a change to 90, is a direct interference with the doctor's practice of medicine. The doctor should make the determination, because they have the relationship with the patient, they know if they are at risk or likely to adhere to the therapies better than an insurer making broad brush strokes based on the cost to insurers. You also skip over the part where doctors get dropped from the insurers network when they don't accept the insurers "recommendations." >The length of the drug prescription does not control the appointment - and anyway you can just call and they'll extend the prescription on the phone. Sure, but that is not how it works in practice, the patients won't set up another appointment until they need another script, which is cheaper for the insurer and worse for the patient outcomes. Nevermind the Doctor being in the best position to determine which patients should be seen every 30 or 90 days, the shorter duration and 30 day appointments lead to higher percentages of drug adherence...which is a major issue in the US leading to about 1 million hospitalizations per year.
  - ars 7y ago
    If the Dr. wants to see the patient in 30 days then they setup an appointment for that. I don't understand why you think the length of a prescription controls the appointments. It doesn't, it has nothing whatsoever to do with that.

chimeracoder 7y ago

> for example changing a name brand to a generic In most states, the law explicitly requires the pharmacist to fill a prescription with a generic (if available) unless the doctor specifically writes "dispense as written". Not allows - requires. The purpose of these laws is to protect patients - in the overwhelming majority of cases, the generic and brand name drugs are equivalent for patients, so patients save money by purchasing the generic medication even if the physician prescribed the drug using its more well-known name (the brand name).

throwaway_tech 7y ago
>The purpose of these laws is to protect patients Its not the patients that lobbies for these laws...it is the insurers, and its to lower their costs. Its also why the insurers pay the pharmacists a bonus for these changes, if it was about costs to the patient, the bonuses (money back) would go to the patient.
- chimeracoder 7y ago
  > Its not the patients that lobbies for these laws...it is the insurers, and its to lower their costs. I mean, no, patients don't lobby for them because patients don't really lobby en masse for healthcare policy in general, but patients definitely are the ones who benefit from them. There are some cases where the relationship between insurers and patients is adversarial. This is not one of them.
  - throwaway_tech 7y ago
    >There are some cases where the relationship between insurers and patients is adversarial. Well imagine your doctor gives you a Rx, you go to fill and the insurer tells the pharmacist to ask doctor to change it. If the doctor disagrees (for whatever reason) the insurer may drop your doctor from their network, then you will be stuck going to a doctor who does whatever the insurer asks. If you feel there is no conflict there or that isn't adversarial that is fine...in my experience both patients who lose their doctor and the doctors themselves disagree.
  - xtian 7y ago
    > because patients don't really lobby en masse for healthcare policy in general See Medicare for All.

ars 7y ago

That's not something similar, and has nothing whatsoever to do with what you replied to. And there's nothing wrong with switching from brand name to generic, and most patients don't need to see their doctor every 30 days, and if they do, they can still make an appointment. The length of the drug prescription does not control the appointment - and anyway you can just call and they'll extend the prescription on the phone.

throwaway_tech 7y ago
>And there's nothing wrong with switching from brand name to generic, and most patients don't need to see their doctor every 30 days, and if they do, they can still make an appointment. For patients with chronic conditions if the doctor determines the patient should be seen to evaluate their condition in 30 days before a new script is written, insurers having pharmacists effect a change to 90, is a direct interference with the doctor's practice of medicine. The doctor should make the determination, because they have the relationship with the patient, they know if they are at risk or likely to adhere to the therapies better than an insurer making broad brush strokes based on the cost to insurers. You also skip over the part where doctors get dropped from the insurers network when they don't accept the insurers "recommendations." >The length of the drug prescription does not control the appointment - and anyway you can just call and they'll extend the prescription on the phone. Sure, but that is not how it works in practice, the patients won't set up another appointment until they need another script, which is cheaper for the insurer and worse for the patient outcomes. Nevermind the Doctor being in the best position to determine which patients should be seen every 30 or 90 days, the shorter duration and 30 day appointments lead to higher percentages of drug adherence...which is a major issue in the US leading to about 1 million hospitalizations per year.
- ars 7y ago
  If the Dr. wants to see the patient in 30 days then they setup an appointment for that. I don't understand why you think the length of a prescription controls the appointments. It doesn't, it has nothing whatsoever to do with that.