The random political thoughts thread (Part Deux)

[BarTopDancer]

Here's a good example of an insurance company wasting money:

When claritin, zyrtec and some other allergy drugs showed up on the market not all of them were covered equally. My doctor gave me samples of each and told me to let her know which one worked best and she'd write me a script for it.

I tried them and determined that zyrtec was the best. I went to fill my script and was told that my insurance would not cover it unless I first had a prescription and tried all the other allergy medication out there, including nasal spray which I cannot take at all. So instead of covering zyrtec, which I knew worked I they would pay for 4 or 5 other prescriptions that I knew wouldn't work or I wouldn't even take before just covering the one that did work.

My doc, who is awesome, went to the insurance company and got them to over-ride it. Thankfully.

[Ghoulish Delight]

Originally Posted by BarTopDancer

Here's a good example of an insurance company wasting money:
...

Actually, they're trying to save money. That Zyrtec prescription could very well cost the insurance company 10, 15, 20 times as much as any of the other brands or generics. So even if they make you go through 4 or 5 other ones and you still end up with Zyrtec, the cost to make you go through that is a drop in the bucket compared to what they stand to save in the long run on the gamble that you'd be happy with one of the other ones. If even 5% of people choose the cheaper drug after that process, they'll have made their money back on those 4 or 5 trial prescriptions they gave to everyone by the time that 5% has come back for the 3rd refill of the cheaper drug.

And anyone can come in and claim they've tried all the others, so yes, it would take a call from the doctor to get around that.

But to me, the fact that this wasn't a waste of money is even worse. This isn't an example of an insurance company throwing money away. It's an example of a very smart business practice, a cost-saving measure that takes very little for them to implement and can save them millions in the long run. But it's at the expense of patient experience and adequate access to benefits.

It's a relatively minor inconvenience. And, in all honesty, probably something a socialized system (assuming medical providers remain privatized) would also engage in to some degree. But it's a good example of how profit-motive from an insurer puts their bottom line, not the health of patients, first.