Penn. Pharmacists Association: “A Patient Walks Up to the Counter …”
By Patricia Epple, Executive Director
Pennsylvania Pharmacists Association
Walk into any pharmacy in Pennsylvania and you will see a familiar sight … a patient goes to the counter with a new prescription in hand from her doctor. She speaks with her pharmacist and confirms her date of birth, insurance information, if she has it, and then the questions begin. How is this drug going to interact with my other medications? How long do I have to take it? Do I need to take it with meals? What are the side effects? And the questions continue.
The role of the pharmacist in our health care system is critical to successful patient care. They are a vital link in direct patient interaction, and they serve as an important resource and information guide for patients once they leave the physician’s office.
Despite their enormous value, the pharmacist’s vital role in patient care is now being challenged by healthcare insurance companies. In response, America’s pharmacists are fighting back on behalf of their patients and profession.
The National Association of Boards of Pharmacy is opposing an all-too-common practice used by insurers to cut costs often at the expense of patient care by forcing a switch from one medication to another. This practice puts pharmacists in the position of denying access to or changing medications that prescribers choose as best for their patients. This practice is dangerous, because it interferes with the continuity of care of a patient’s drug therapy, especially when those patients are already well maintained on a medication regimen, and can potentially put patients at risk for harmful side effects their provider may have been trying to avoid by choosing the original medication.
These types of insurance practices, which can be in direct conflict with current state and federal rules and regulations, compel pharmacists to compromise their time and their ability to interact with patients as deemed necessary and appropriate by the boards of pharmacy. Thus, rather than focusing exclusively on patient care, pharmacists are forced into the quagmire of insurance regulations and are often pitted against prescribers through the forced switching of medications. This can cause serious ethical concerns for pharmacists as well. By insurers engaging in what could be interpreted as the practice of pharmacy and/or medicine, the question becomes – who decides what is best for the patient?
By the most basic definition, pharmacists are engaged in the practice of evaluating medical orders and preparing, preserving, compounding and dispensing medical drugs. They work closely with patients to answer their questions and ease concerns regarding prescribed medications, and they serve as a frontline healthcare provider. It’s a role they relish and a role that has been around for centuries.
When insurers force a switch from one medication to another or they deny a medication recommended by a prescriber all together, everyone loses. Patients lose access to important healthcare. Prescribers lose the ability to treat their patients as they feel appropriate. And, pharmacists lose important time sorting through hours of paperwork and phone calls on each claim that should be spent on patient care.
At a time when our country is considering broad sweeping changes to our health care system, it is critical for our nation’s insurance regulators to prohibit any insurance company or managed care organization from engaging in these types of insurance practices. The American Medical Association will actually consider a proposal at its June meeting that would create a Healthcare Insurer Code of Conduct to address many of these types of issues. If passed, this proposal would ask insurers to voluntarily adopt and release publically codes of conduct that would ensure transparency of their rules and regulations, provide healthcare providers with more clinical autonomy and put patient care and patient health first.
Each healthcare provider has a unique role to play in the delivery of healthcare in Pennsylvania and across the country. Preserving those roles, and their integrity, is integral to the continuum of successful patient care.
We can only hope that sometime soon, when a patient goes into a pharmacy to get a prescription filled, that the pharmacist can focus solely on answering her questions and handing her the medication she was specifically prescribed.
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All News Items
August 26, 2010 - The Lund Report: The Best Care Possible: You're Worth It
June 14, 2010 - American Medical News: 10 things health insurers must do to regain trust; The AMA, with endorsement from 68 state and medical specialty societies, outlines steps health plans must take to be credible in the eyes of physicians and patients.
February 27, 2010 - Providence Journal: The creepy third person in doctor’s exam room
November 28, 2009 - Newport News Daily Press: MDs under attack
November 04, 2009 - The Hill: A code of conduct for health insurers
October 27, 2009 - WCBU-FM 89.9 (Peoria, Ill.) radio news
October 26, 2009 - WEEK (NBC - Peoria, Ill.): Developing a doctor-patient relationship
October 12, 2009 - Las Vegas Business Press: Here's a prescription: A health insurers code of ethics
September 09, 2009 - Maryland State Medical Society Resolution 14-09
August 29, 2009 - The Island Packet: AMA code puts doctors, patients in charge of care
August 28, 2009 - Baltimore Times: Group calls on health insurers
August 27, 2009 - Baltimore Times: Nursing Maryland back to health
August 20, 2009 - Lincoln Journal-Star: Pharmacists forced to serve insurers rather than patients
August 19, 2009 - WSTM-NBC3: Prescription medication battle heats up in Central New York
August 17, 2009 - New York State Senator Jeffrey D. Klein blog: For Health or Profit? Klein Unveils Sickly Scorecard of Major HMOs
August 17, 2009 - New York Daily News: Prescription Prescription drug coverage marred by bureaucracy, survey says
August 13, 2009 - Leading African American Groups Call On Health Insurers to Dismiss Restrictive Practices
August 13, 2009 - San Diego Union-Tribune: Bureaucracy won't contain costs
August 01, 2009 - Huntington, W.V. Herald-Dispatch: Insurers put stress on the physician-patient relationship
July 21, 2009 - Chicago Tribune: They authorized back surgery but denied his $148,000 claim
July 17, 2009 - American Osteopathic Association calls for Development of Code of Conduct
July 12, 2009 - Houston Chronicle: Another kind of remedy for the sick; Code of conduct would protect patients
July 07, 2009 - Washington Post: Health Reform: Who Holds the Reins on Care?
July 06, 2009 - NATIONAL HEALTH INSURER CODE OF CONDUCT HITS 1000 SIGNATURES OF SUPPORT
June 30, 2009 - Atlanta Journal-Constitution: Code of conduct needed for health insurers, too
June 24, 2009 - Penn. Pharmacists Association: “A Patient Walks Up to the Counter …”
June 24, 2009 - Pittsburgh Post-Gazette: Broken bonds; The physician-patient relationship is being destroyed by the cost-driven decisions of health insurers
June 09, 2009 - Bellingham (Wash.) Herald: Time for a health insurance code of conduct
June 08, 2009 - Mississippi Business Journal: Transparency is the best medicine; Health Insurer Code of Conduct may improve the quality of care
June 03, 2009 - Frederick (Md.) News Post Op-Ed: Pharmacists pawns in health care's game of chess
June 01, 2009 - KUSI-TV interview with Dr. Jack Schim
May 25, 2009 - San Francisco Chronicle: Doctor pushes back against insurer scrutiny
May 08, 2009 - Fox News Health Blog: Bad Medicine: Is Your Insurance Company Hazardous to Your Health?
April 27, 2009 - Petition for Health Insurer Code of Conduct Garners Widespread National Support
April 20, 2009 - On-line petition launched in support of a national health insurer code of conduct
April 13, 2009 - Petition launched in support of a national health insurer code of conduct
April 09, 2009 - Westchester (N.Y.) Herald letters: Access to Quality Healthcare
April 01, 2009 - Los Angeles Society of Allergy, Asthma & Clinical Immunology Applauds the AMA for Developing Health Insurer Code of Conduct
March 24, 2009 - Arizona Republic: Patient care, not financial gain, must take priority
March 22, 2009 - Rochester (N.Y.) Democrat and Chronicle: Health insurers should agree to a code of conduct
March 20, 2009 - Buffalo News: Code of conduct would protect patients from insurers
March 10, 2009 - AfPA Launches Petition in Support of a National Health Insurer Code of Conduct
March 09, 2009 - Texas Medical Society: Health Insurance Code of Conduct Act of 2009; The Time Has Come
March 09, 2009 - American Medical News: MSSNY president: Insurer settlements highlight need for code of conduct
February 01, 2009 - Colorado Medicine: Health Insurer Code of Conduct?
January 24, 2009 - Fresno Bee: Doctors push code of conduct for insurers
December 10, 2008 - Lupus Agencies of New York State Applaud AMA's Resolution to Develop a "Code of Conduct" for Health Insurers
December 09, 2008 - New York State Rheumatology Society Position Paper: AMA Resolution 823
November 20, 2008 - National Minority Quality Forum Applauds AMA's Health Insurer Code of Conduct
November 14, 2008 - Alliance for Patient Access Applauds AMA's Health Insurer Code of Conduct
November 13, 2008 - Alliance for Better Medicine Calls on California Health Insurers to Adopt a "Code of Conduct"
November 13, 2008 - Los Angeles County Medical Association Reinforces AMA's Call for a Health Insurer Code of Conduct
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