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One Doctor’s Fight To Get His Patient The Right Medication

“Doc, I’ve got good news and bad news.”

“What’s that?”

“Well, I’ve lost six more pounds!”

“Wonderful! What’s the bad news?”

“Well, you know that new-fangled drug you gave me that works so well for my atrial fibrillation?”

“Yes.”

“We’ll, I’m part of that AARP Medicare Advantage Part D drug plan, and I just got the “partial” approved drug list for 2010 in the mail. My drug’s not on the list, so I called and found the drug’s been moved from a Tier II drug to a Tier III drug. That means it will cost me twice what I paid for it this year. That’s gonna be tough, doc. I can’t afford it.

But I also read that if you call this ’800′ number and speak to them, they’ll allow me to obtain an exemption to keep the drug on Tier II for next year.”

I called the number as I typed his note. The patient seemed pleased that I’d be so attentive to his needs during their office visit. A sophisticated voice-recognition triage prompt answered:

“If you’re calling about an injectable insulin question, say ‘insulin,’ drug issue say, ‘drug,’ if not part of this list, say ‘other,’…”

“Drug,” I said. a brief pause occurred, then:

“Just a moment…” (Soft music played in the background.)

Finally, a woman answered. She was quite pleasant as I explained the situation. Finally, I got to the part about the patient’s drug not being on the 2010 drug list.

“Oh, 2010?” she asked.

“Just a moment.”

On hold again. We continued our office visit. “So, how often are you having those episodes of…”

“Dr. Fisher?”

“Yes?”

“What other drugs has the patient failed?”

We listed them: “Atenolol, Sotalol, Amiodarone…”

“And when were those drugs used?”

“Um, seriously?”

“Yes, I need dates.”

“Well, according to the fancy-schmancy electronic record, he’s been on this Wonder Drug since November 12, 2007… his Amiodarone was stopped then.”

“But the other drugs, when were they started and stopped.”

I made up some dates. I was not about to spend time culling the record for these dates, but it was clear that data entry fields were being placed on the opposite phone line. I suggested to my patient he write down those dates.

“And why was the Amiodarone stopped?”

I looked at my patient. He quickly reminded me about the lung findings and liver toxicity he had experienced. I spewed the information to the inquisitor in hopes of expediting the interview. It was taking entirely too long. I looked at my patient. This would be his visit. His priorities were set: money talks after all. So I continued. After submitting the answers, she responded:

“Just a moment while I give this information to my supervisor.”

Soft music played again. I looked up at my patient. “Um, where were we? Oh, yes, how often have you been…”

“Dr. Fisher?”

“I’ve given the information to my supervisor.”

“Okay, will he receive his Tier exemption?”

“Oh, we’ve not received the final list yet for 2010.”

“But my patient called and discovered this drug was moved from Tier II to Tier III. Why does he know the information and you seem puzzled by the list?”

“As I said, we’re still waiting for the final list…”

It was obvious that the discussion was going nowhere.

“So how will Mr. Smith know if he’s been granted the exception?”

“My supervisor will review the application for the Tier review and make a decision. Is there anything else you need?”

Realizing that there was no way I was going to get an answer, I acquiesced. “No, I think we’ve handled the application. Thanks for all you help. By the way, in case my patient would like to check on the application, what’s your name?”

“Christine.”

“Thanks, Christine. And your last name?”

“It’s just Christine.”

“Uh, okay. And how about your supervisor’s name?”

“Jericho.”

“Jericho who?”

“There’s only one Jericho here,” she said.

I could only think one thing at that point as I hung up:

… I bet he’s a “wall.”

*This blog post was originally published at Dr. Wes*


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