Multiple Sclerosis: Formulary Issues
- Monday, August 10, 2009, 10:16
- Multiple Sclerosis
- 356 views
- Add a comment
- Dick:
- Here is an e-mail question from Ann in Michigan. “We recently changed insurance coverage, and now they want me to change from one interferon to a different interferon because it is on their formulary. Is this right? What can I do to fight this if I disagree?”
- Jan:
- I’m sure her physician would be very comfortable in writing a strongly-worded letter to the insurance company indicating why that medication was chosen and the fact that you’ve been on it for whatever period of time and how it works for you. We’ve had fairly good success with that – they would prefer that you use that [medication on formulary], but once there is a letter of documentation from the physician why that other one was chosen, generally they will support that choice.
- Dick:
- And add that medication to their formulary?
- Jan:
- Not necessarily, no, I can’t say that, but they will allow it in that particular patient situation.
- Dick:
- On a case-by-case basis. Does that sound like good advice, Dr. Frohman?
- Dr. Frohman:
- I have to tell you that my understanding is that these drugs should be available on all of the formularies. These are not like we have two or three non-steroidal anti-inflammatory analgesics, and take a pick – they’re all pretty similar. Probably the best example is Avonex versus Rebif. They’re both interferon beta 1A, but they are delivered differently. Their regimen is different. These drugs are decided between the physician and the patient in terms of what is right for the individual patient. We use all of the drugs, clearly. And I think they’re all great. But I am very concerned about what happens with these pharmacy programs.
What happens is they negotiate with these various companies, and when they get a better price break or it’s financially advantageous to the company, they will then elevate the preference status of one drug and subordinate the preference status of another. That only serves the benefits of the pharmacy groups. It does not serve the interests of the patient.
I never allow a pharmacy group to make a decision about a drug that I want to choose for a patient, and I have never had an example where I could not get on the phone or even write a letter. They immediately will back down and will approve these drugs.
So, this is not like dealing with analgesics of slightly different names. The way they take them, how often they take them, in the skin, in the muscle. Not better or worse, but different. This is a decision between the patient and the physician and the participating care staff.
About the Author
admin has written 208 stories on this site.
Write a Comment
Gravatars are small images that can show your personality. You can get your gravatar for free today!