THE BLOG

Generic Swap Meet

04/25/2009 05:12 am ET | Updated May 25, 2011

Welcome to the Generic Swap Meet!

Also known as health care in the United States. Guess what? It doesn't matter where your doctor, nurse practitioner or PA went to school, or how much time they spent taking your health history or examining you. Don't worry about those little details. And the medication they prescribed? Oh, that's just a suggestion. You see, they may be writing the prescription and you may be taking it to the pharmacy, but we all have to wait for the real "Decider" to figure out if it's in their best financial interest for you to take that medication.

Who really decides
Sorry, let me back up a bit. You see, you may have your own health care provider, who has actually met you, examined you and spent some time with you, but often, the decision about what medication you will end up taking for your condition, well, that's up to someone else.

Someone you've never met, who doesn't know much about you, except your social security number, your age and your diagnosis. Oh, hold on, what they do know, is the least expensive medication approved for that diagnosis. It doesn't matter if you've already tried the alternative and you had side effects, or it didn't work. That doesn't matter. You see, it's better for the health of your insurance company not necessarily for your health.

Form letters
There are days when I receive a stack of faxes from insurance companies with polite wording with not so subtle suggestions that I re-consider my treatment plan for the patient that I examined, that I took a history on, and that I actually spoke to. You see, they want me to consider an alternative medication for this patient, one that costs less. Guess what guys? I already considered those, because I don't like getting these faxes.

People are doing well on their medications. Then, their insurance changes and a new company evaluates their treatment options and sends the letter. Sometimes the medication gets switched not because of an enhanced therapeutic benefit, but because it costs less.

Unfortunately, in many cases and especially with epilepsy medications, not all are interchangeable. There are consequences. There have been more than 1,000 reports of people suffering seizures after having their medications switched. This is a tragic consequence to a decision that was made by companies who are NOT familiar with the individual patient and their history. Who suffers? Not the insurance company. The person.

These Letters Make Me Cringe

And frankly, I resent these form letters. They're from an anonymous source, one, who never met the patient, never examined them, and probably never actually practiced health care. Yet, there on a stack of charts that represent actual human beings, sits an insidious form letter from a source that's not dedicated to saving lives, but to saving $.

I understand the need to cut costs, but in my opinion, some insurance companies are practicing health care without a license. They have none of the liability and yet are part of the decision-making? What's up with that?