September 13, 2013
1 min read

A few thoughts on reimbursement

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Health care is getting out of control and I am not referring to “Obamacare” — I readily admit to not being up to date with what has or has not been passed on Capitol Hill.

Early this morning, I got an email from a patient requesting I put in a prior authorization for his Freestyle test strips. He had purchased a new meter a few months ago but was told that test strips for his new meter were no longer approved. Prior authorization worked, but at what expense? See his email below.

"Thank you for trying … If I was drug addict trying to obtain narcotics, I might be able to understand the necessity for such stringent rules. But for a glucose test strip? Really!”

Later, I got a call from a nursing home about a patient in whom glycemic control was not as good with insulin detemir (Levmir, Novo Nordisk) as it had been with insulin glargine (Lantus, Sanofi-Aventis), but her insurance no longer covered her Lantus. Not a difficult problem to solve, but again, it was time-consuming and the rationale was lacking.

These seem like minor nuisances, but patients do not recognize that. Rather, they feel that the effort they had put into their own management of their diabetes has been for naught.

I see this most often in patients with diabetes, but it happens in many other endocrine conditions, and I am sure in all other primary and specialty care teams.

One cannot blame the pharmacy or any other business for seeking the best deal they can, but patient care and safety surely takes precedence.

Your thoughts and/or advice?