(Snippets from the frontline)
Prescription denied
He was an opera coach with a deep melodious voice. Now in his 80’s, my patient uses a walker and suffers from lumbar spinal stenosis causing persistent pain, yet controlled by medication allowing him to remain independent.
I had seen him the week before, so his narcotic prescription (acetominophen with codeine) was routine and had not changed in years.
But during my phone call renewal, the pharmacist asked if other pain relievers had been used and politely I said “no.” His response, “why not?” I told him the patient was stable; not overusing the medication; it was effective without side effects; and there were no signs of addiction. “Denied.” Questioning his rationale, he “did not feel comfortable with it.”
I queried “Have you ever met this patient? Have you asked him about his pain? Did you ever perform a physical exam, or see his CT scan results?” Still denied.
Even complaints to the national office were to no avail, as they supported decisions made by their pharmacists.
We have an opioid crisis and prescription misuse exists, but a denial like this is practicing medicine without a license.
Doctors must be the decision-maker.
Gene Uzawa Dorio, M.D.
My mother has had 3 hip replacements and on the last one contracted E. coli and a staff infection while in the hospital . Her hip hardware had to be removed. This has left her with 5 inches missing from her leg . She is in constant pain and only gets meds to help her let a somewhat functional life . She is 80 years old and why would any body deny her from trying to live a pain free life because “they” are worried that she might become addictive. The opioid crisis is not over prescribing but under prescribing to patients that are legit . I myself am going in for knee surgery and I hope my insurance company doesn’t think that tynenol will do the job after surgery . God help us all if that is the case.
You can take him to court: Contact AAPS.
There are a host of deeper case mgmt strategies that could be used but are typically NOT on the formulary of insurance companies. There is a lot to be learned about the addicted patient via psychological testing, brain imaging, complex history taking and family interviews. My colleagues in Europe approach cases like this. But in America under the current mobster insurance company/pharma regime, we look at the easiest and least expensive way and apply a One Size Fits All Approach. I always use the analogy of The Seven Blind Men and the Elephant to describe how we partially factor sciencein and otherwise use the “looks like a duck” diagnosis and treatment.
I agree, physicians should be prescribing, not insurance companies or pharmacists. If a person is old and in chronic pain, what difference does it make if he/she is addicted?? Do you want to die in pain? We need common sense laws, not absolutes.
Agree physicians should make Rx decisions
We also have no obligation to prescribe a Rx that insurance will pay for
#90 tabs of 30mg codeine costs under $30.00 cash with GoodRx, without any insurance
For that price, why deal with the hassle of even arguing with insurance
We need to get away from this addiction to a payment system that we want to cover every last little thing
Insurance denial does not mean the patient “can’t have it” only that they won’t pay for it: if it’s cheap, the patient and physician think it’s important, then the patient pays cash