Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I am myself a pharmacist in BC, and you're close to right, but you've gotten a couple things mixed up. The physician can write "no substitution" and initial a prescription so that pharmacists will not dispense an interchangeable drug of another brand (like a generic medication). The form that physicians fill out for certain patients is an application for Special Authority coverage and is a separate thing, usually sent to either a provincial prescription drug coverage plan or an insurance company (separate forms for each). This is to ask that a drug that is not normally covered be paid for because the patient has met certain criteria and it is deemed necessary. This usually works for a six month period before reapplication is required for continued coverage. I asked about what an insurance pharmacist was as I've never heard of a professional who does something like the other poster described, even in a US context, which is practice context that I admittedly know little about, as the particulars cannot impact my own patients. Most of the few pharmacists who work in insurance work at a policy level and help the companies decide which drugs they should cover and which they shouldn't, but make no decisions on individual claims. They might also be involved in auditing claims by pharmacies on behalf of patients to ensure they're doing so by the book, but this is much less common and also involves no direct patient interaction.
It is exactly what it sounds like -a pharmacist employed by the insurance company to who vets prescription drugs claims. And yes, there is patient interaction. In fact my contact had to fight for his name brand medicine when a generic did not exist with the same active ingredients. Which means that the insurance company recommended him an alternative and not a generic at all -contrary to doctor's orders.
You know what's funny? Here in U.S., with the Oh Bummer Care, I no longer feel that I truly have a choice - as far as private health "insurance" is concerned: My employer's plan is a crappy super-high deductible plan. I would like to get another one, better priced and low-deductible. And guess what - I MUST enroll only during a very specific time window during the year, MUST contract the services of a "provider" that MUST be from the same state, and pick up from just a few "bronze", "silver" or "gold" plans. Which are never affordable price wise anyway.
Isn't that ... SOCIALISM, ahem?
Boo to Oh Bummer Care: a communist trick that shifts money from the so-called "middle class" to the poor. And making this "Affordable Care" - paradoxically - un-affordable for the middle class. And it is the insurance pool of healthy individuals who has to suffer, definitely. And the private insurers are now feeling the pain. And many are just leaving the "market".
Socialism isn't pure evil, nor is capitalism. Going 100% either way however will bring about certain upheaval. Socialism works for essential services as every other western nation can attest to (unless you do not consider healthcare essential). And like it or not there is significant momentum towards it within the USA. During my recent visits, it seems that people want to talk about it, they are very curious about it, and this is in the South from people with good jobs and unsatisfactory plans like yourself.
Obamacare is strange I'll give you that. The more I hear about it, the stranger it sounds. It is unlike any other western healthcare system that's for sure. It sounds like a temporary fix using the incumbents (insurance) to get everyone covered. Problem is, the incumbents were designed around something else (free market and profit) and not for providing care for everyone.
Socialism isn't pure evil, nor is capitalism. Going 100% either way however will bring about certain upheaval. Socialism works for essential services as every other western nation can attest to (unless you do not consider healthcare essential). And like it or not there is significant momentum towards it within the USA. During my recent visits, it seems that people want to talk about it, they are very curious about it, and this is in the South from people with good jobs and unsatisfactory plans like yourself.
Obamacare is strange I'll give you that. The more I hear about it, the stranger it sounds. It is unlike any other western healthcare system that's for sure. It sounds like a temporary fix using the incumbents (insurance) to get everyone covered. Problem is, the incumbents were designed around something else (free market and profit) and not for providing care for everyone.
Those Americans I've discussed this with in depth have come to the conclusion after studying some of the limitations and requirements that it was designed to be merely a stop-gap measure to precipitate discussion and impetus for further change.
A Trojan Horse, if you will. Something to get through the gates of hereditary multi-generational repugnance at any mention of universal or "free" healthcare that has been vilified for decades. It's worked in that sense.
People are sure talking about it now and just hanging at the pool bar in Florida now is a tiresome exercise as the subject comes up every single time. I'm even being asked questions while riding a golf cart with members of our foursome like "how often have you been denied a treatment by your government run plan"? I'm in my 70's so you can only imagine the flummoxed looks of disbelief I get when I tell them "never" and describe all of those ailments I've received treatment and hospitalization for in my lifetime without ever once seeing a bill.
The movement has started that probably will not stop until they've got a working system in place. Now it falls to Canada and our provincial leaders to see to it that the wheels don't fall off ours over their stupid fiscal decisions over things like Ontario's fubarred electrical services and subsidizing solar at taxpayer expense.
I'd like to hear from Edward about this. I haven't followed the whole US health care issue and don't claim to know how it works but it did recently catch my attention that under Obamacare premiums are set to rise a very great deal. I guess I'm wondering just how Obamacare could ever have been presented as an affordable alternative for anyone.
Americans may have been conditioned to believe a UHS is bad by their media and fight against the idea because of this but I also don't think they could ever have a copy of our exact model because of their population size and other complexities.
To Americans: You will never have a model like ours exactly, you may never have any model of UHC at all because of your alt-right.
Those Americans I've discussed this with in depth have come to the conclusion after studying some of the limitations and requirements that it was designed to be merely a stop-gap measure to precipitate discussion and impetus for further change.
A Trojan Horse, if you will. Something to get through the gates of hereditary multi-generational repugnance at any mention of universal or "free" healthcare that has been vilified for decades. It's worked in that sense.
People are sure talking about it now and just hanging at the pool bar in Florida now is a tiresome exercise as the subject comes up every single time. I'm even being asked questions while riding a golf cart with members of our foursome like "how often have you been denied a treatment by your government run plan"? I'm in my 70's so you can only imagine the flummoxed looks of disbelief I get when I tell them "never" and describe all of those ailments I've received treatment and hospitalization for in my lifetime without ever once seeing a bill.
The movement has started that probably will not stop until they've got a working system in place. Now it falls to Canada and our provincial leaders to see to it that the wheels don't fall off ours over their stupid fiscal decisions over things like Ontario's fubarred electrical services and subsidizing solar at taxpayer expense.
The people I've spoken with regard universal care as an inevitability and there's a sense of optimism with that prospect -even if they absolutely despise Obamacare. They're just really frustrated with all the conditions and costs of their current plans.
Interesting idea about the Trojan horse. I hope that is indeed the case and not pure naivete that negotiating with free market incumbents to cover everyone will just work out.
In the end, I think the biggest concern with any sort of implementation is still supplier cost. The latter won't be giving up their fat margins without a serious fight, which means affordability may not change much fast. It will take decades. The recent wallstreet trend is going the opposite direction: purchasing patents/companies, increasing the price of staples, and thus profitability.
The sentiment from part of the populace regarding taxation and what belongs to them also won't help. I would like to think that it's only a very vocal interwebs minority.
Last edited by CloudReader; 11-01-2016 at 08:05 AM..
The people I've spoken with regard universal care as an inevitability and there's a sense of optimism with that prospect -even if they absolutely despise Obamacare. They're just really frustrated with all the conditions and costs of their current plans.
Interesting idea about the Trojan horse. I hope that is indeed the case and not pure naivete that negotiating with free market incumbents to cover everyone will just work out.
In the end, I think the biggest concern with any sort of implementation is still supplier cost. The latter won't be giving up their fat margins without a serious fight, which means affordability may not change much fast. It will take decades. The recent wallstreet trend is going the opposite direction: purchasing patents/companies, increasing the price of staples, and thus profitability.
The sentiment from part of the populace regarding taxation and what belongs to them also won't help. I would like to think that it's only a very vocal interwebs minority.
It almost appears as though major medical entities like drug companies have reached the conclusion that some efforts are going to be turned towards them to affect pricing control so they've decided to raise costs exponentially regardless of public outcry bringing spotlights on them.
They appear to have made the conscious decision to make out like bandits while they still can and to heck with the consumer's well being. Their only oversight is provided by those they've lobbied successfully for decades. Just googling the net-worth of the average congressman is an eye-opening exercise. They go in that transporter booth moderately well-off and after getting beamed up by Scotty emerge at the other end multi-millionaires.
All of this is just an opinion of course, but it is after all only a natural, and to be expected, occurrence with the so called free-market system allowing various entities to collude on price fixing and corrupt the overseers. Like no one would ever anticipate they'd resort to doing underhanded stuff like that.....eh?
It is exactly what it sounds like -a pharmacist employed by the insurance company to who vets prescription drugs claims. And yes, there is patient interaction. In fact my contact had to fight for his name brand medicine when a generic did not exist with the same active ingredients. Which means that the insurance company recommended him an alternative and not a generic at all -contrary to doctor's orders.
Interesting that they employ pharmacists in that capacity. So the Insurance pharmacist said that the company doesn't cover the brand and recommended an alternative medication in the same class that was covered, and your friend chose not to accept the alternative? That's a long way from the insurance company just switching the drug without the patients knowledge, which didn't seem to make sense because the actual pharmacy dispensing it would have had to do that and it's not happening without patient and physician consent. Fundamentally though, I don't see anything wrong with using a lower cost alternative when evidence of superiority doesn't exist for some brand name. GPs don't know very much about different drugs in a class compared to pharmacists if we're speaking generally, it's not their area of focus, and if you can't afford the brand because you didn't purchase insurance that covers everything, it's better to be recommended an alternative in the same class then be told to suck it up and shell out for the high priced alternative you can't afford. At least then, you have a choice and can make a decision according to your own circumstances and values, and can consult with your own community (not insurance) pharmacist to make one informed by evidence.
He know's he's lying as he's not only gotten everything wrong, he's done a complete 180 degree turn from his earlier position regarding healthcare reform and Canada.
Interesting that they employ pharmacists in that capacity. So the Insurance pharmacist said that the company doesn't cover the brand and recommended an alternative medication in the same class that was covered, and your friend chose not to accept the alternative? That's a long way from the insurance company just switching the drug without the patients knowledge, which didn't seem to make sense because the actual pharmacy dispensing it would have had to do that and it's not happening without patient and physician consent. Fundamentally though, I don't see anything wrong with using a lower cost alternative when evidence of superiority doesn't exist for some brand name. GPs don't know very much about different drugs in a class compared to pharmacists if we're speaking generally, it's not their area of focus, and if you can't afford the brand because you didn't purchase insurance that covers everything, it's better to be recommended an alternative in the same class then be told to suck it up and shell out for the high priced alternative you can't afford. At least then, you have a choice and can make a decision according to your own circumstances and values, and can consult with your own community (not insurance) pharmacist to make one informed by evidence.
Except for initially, insurance never told him that it was an alternative; they simply said that they can offer a "generic". To most people that would mean the same active medicinal content as the name brand. But later, when he checked it out over the internet, that was not the case. The pharmacist never contacted his doctor either.
I don't know if this guy's doctor is very knowledgeable about this type of medication or not, but I expect a pharmacist to explain and inform the patient if he/she has an alternative/recommendation. What makes it worse in this case, is that the patient is very sensitive to potential side-effects and did not appreciate the change without the proper info.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
