“Medicare for all,” who are they kidding. The medical world will never be free from the profit mongering insurance industry. Upset about the cost of medical care? Take one look at the profit statement of any health insurance company or Pharmacy Benefits Manager and you’ll realize where the real money is!
For one moment, look beyond the insurer’s bottom line profit and look at their gross income. Realize that there are thousands of people making billions of dollars running one of the largest bureaucracies in the world. Now, add to those numbers the added overhead your doc shoulders in coders, billing staff, and time spent in prior authorization activities and you’ll realize why we have the most expensive medical system in the world. We also have the insurance industry feeding money into almost all of the political campaigns, assuring the continued control over healthcare in the US.
So, when I tell you I’m angry, you shouldn’t be surprised. What you might find surprising, is why I’m angry today. I’ve accepted the fact that my profession has been kidnapped by terrorist in the guise of insurers and Medicare. I’ve accepted that we will forever be enslaved by those who steal our precious healthcare dollars all the while blaming the cost on those greedy, inefficient docs. What I can’t accept is the human suffering caused by the insurer’s quest for ever growing profits.
With the New Year comes new formularies. Major Pharmacy Benefits managers (another name for insurer) will decide to take product number one off formulary and replace it with product number 2. All patients covered by their organization will be forced to change medications as of January first. If my patient refuses to abandon the treatment that has worked well for him/her over the years, he/she will be forced to pay an exorbitant fee to continue on your current medication.
Why force a large number of patients to abandon their previously successful treatment and take a chance on getting ill? PROFIT, pure and simple! The insurer has found a way to cut its expense and is willing to potentially sacrifice the health of its customers for a larger profit margin!
Unfortunately, patients will need to see their docs before starting on their new medicine and may well need to have multiple visits to the doc’s office before they are stable on their new medication. Some will not do well on their new medication and some may even end up in the hospital.
The pity of the matter is that to increase the Pharmacy Benefits Manager’s (PBM) profit, both the patient and the health insurance company that covers the patient’s office visits will be forced to incur the added expense associated with the medication change.
It’s utter madness! We should all be sick of it! Unfortunately, there is not much we can do about it and, next year, the PBM’s formulary is likely to change again.
