(This post has been updated to correct any misinformation in its previous version.)
Well, Missouri, the “Show Me” state, is living up to it’s name. You want to fill a prescription there? You want it to be generic? It has to be on their generic formulary.
Each state, you see, has it’s own generic substitution formulary, unless the generic subsitution has been mandated by the FDA. If a drug is on a state formulary, it can be substituted by the pharmacist as long as you don’t specify otherwise. If a generic exists, and it’s not on the state formulary, the physician has to ask for that generic by name.
Why should I care about Missouri’s formulary?
Because now that Aetna/US healthcare has bought a mail order pharmacy in Kansas City, I am told that the scripts I write for patients in that plan are being filled according to Missouri state formulary. Not a few drugs I frequently write that once were automatically substituted here do not have generics in Missouri. And my patients are getting hit with the difference.
I was asked by a patient today to rewrite all her scripts with specific generic names so she could mail them away. Otherwise, she would end up paying full price for the brand name, as had happened to her (and her husband) three months ago when they first filled scripts at Aetna’s new pharmacy. Surprise! Your former $20 copay drug is now $150. Already filled and deducted from your credit card, sorry.
It’s hard enough to keep track of my own state formulary, let alone those of the other 49 states where big insurers might want to buy a pharmacy. And now I have to keep track of the generics out there, and decide which generic I want to write if it’s not on a state’s formulary. (Not to mention the confusion and burden on my patients.)
I do not have the information needed to decide which generic I should write, do you? When it comes to oral contraceptives, multiple generics can exist for a single formulation. I can’t tell them apart. I write the brand name, and let the FDA and the pharmacist do the rest.
Maybe I’m too trusting. Maybe I should keep track of all the generics out there. Maybe I should care which generic my patient gets. But I don’t.
Am I wrong?
Medicine is getting more and more complicated and more and more time consuming.
It’s amazing how much time I spend writing authorization forms, disability forms, paperwork for the hospital, tumor board forms, and multiple other things.
As for scripts, writing the correct number, 3 months for write-aways, and pharmacies that do not have what I ordered.
The system will eventually reach a breaking point where it is impossible to take care of patients the way I would like to.
Call the mail order pharmacy and find out. There’s usually a number for the pharmacy service on a patient’s insurance card (at least there always has been for mine). I’m assuming you have a photocopy of the patient’s card in her file.
When you call these pharmacies, almost always, the first option is ‘if you are a provider, please press 1’.
Another option is to call the insurer. They also will have a pharmacy services department. Or check the insurer’s website; they may have their policies posted there.
The patient may have misunderstood, or been given wrong information from an employer, or even a friend. I’ve had that happen to me with previous employers.
I don’t think there’s anything wrong about starting a discussion about this on your blog. But now Kevin MD has linked to this thread, which means the state of Missouri will be ripped to shreds, without there being definitive information about this generic policy.
MMM:I know, I am trying to find it out. Not being at the office, I don;t have the name or number of the pharmacy in question. I left a comment over at Kevin to stave off any misconceptions, and sent him an email…
I was going to take thism post down till I figured it out, but that would leave Kevin’s link out there perhaps misleading…
The power of the Web, Huh?
dr. domenico,
what do you mean, eventually?
The system IS at a breaking point. Any more breaking point than this and it will explode!
Why can’t you just prescribe using the generic name? (that’s what I do unless it’s a combo drug without a short generic name: eg cotrimoxazole).