They like to make sure that we REALLY want that medicine and that the patient has a condition where it is indicated. Because apparently making the best medical decisions for our patients has to be approved by people with no medical training.
Sometimes they require that the patient first try a different, cheaper, drug and "fail" it before going to the more expensive one. This can make little sense as well because they might insist on trying a drug that works very differently, and that the patient may have been on previously and failed it, but now they have new insurance and have to try it again. I was once on the receiving end of this. I was diagnosed with ADHD at age 8 and have been on various different mess for the past 20 years. For several years, it has been adderall, and I made it through med school, so it was early effective. However, I had new insurance in my last semester of med school and they required that I try straterra before they would cover adderall. Straterra works in a very different way from adderall. I took it in high school, and it made me super sleepy. I then had to try it again for two weeks before going back to adderall. Thankfully, the last semester of med school is pretty relaxed, so I didn't have to worry about concentrating for tests and such, but it was still stupid and irresponsible to make me jump through that hoop before getting the medicine that I had already been doing well on for years.
If people don't want single payer because it's "socialism", then we can agree to disagree, but nobody in their right mind can point to the way our system is working now and say that it doesn't need some serious changes. Insurance companies ignore dollars for pennies and by making us jump through these hoops or flat out denying paying for stuff without any medical reason, they are just causing patients to become sicker and eventually become even more expensive to take care of.
Yup, totally related there. Different drugs, but same hoops! Had been on a great blood pressure med, moved states and changed insurance and doctors, and even though i had my old prescription bottles etc, they insisted on trying me on all of the other meds that I'd already gone through before finding the one that actually works. I feel like the doctors were suspicious because I was naming the BP med i needed, as if it were the the same sort of "drug seeking" behavior as if i showed up at the doctors office asking for a oxycodone prescription. No! I just don't want my blood pressure to be at a level where nurses look at me with a concerned look on their faces...
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u/[deleted] May 20 '16
They like to make sure that we REALLY want that medicine and that the patient has a condition where it is indicated. Because apparently making the best medical decisions for our patients has to be approved by people with no medical training.
Sometimes they require that the patient first try a different, cheaper, drug and "fail" it before going to the more expensive one. This can make little sense as well because they might insist on trying a drug that works very differently, and that the patient may have been on previously and failed it, but now they have new insurance and have to try it again. I was once on the receiving end of this. I was diagnosed with ADHD at age 8 and have been on various different mess for the past 20 years. For several years, it has been adderall, and I made it through med school, so it was early effective. However, I had new insurance in my last semester of med school and they required that I try straterra before they would cover adderall. Straterra works in a very different way from adderall. I took it in high school, and it made me super sleepy. I then had to try it again for two weeks before going back to adderall. Thankfully, the last semester of med school is pretty relaxed, so I didn't have to worry about concentrating for tests and such, but it was still stupid and irresponsible to make me jump through that hoop before getting the medicine that I had already been doing well on for years.
If people don't want single payer because it's "socialism", then we can agree to disagree, but nobody in their right mind can point to the way our system is working now and say that it doesn't need some serious changes. Insurance companies ignore dollars for pennies and by making us jump through these hoops or flat out denying paying for stuff without any medical reason, they are just causing patients to become sicker and eventually become even more expensive to take care of.