Thread by @life_is_art___

Is there any other class of medications that are routinely reduced by a #pharmacy/ #pbm? It just baffles me how discriminatory policies that put barriers in place are allowed to continue. How do Mds feel about being second-guessed constantly by these companies? #DEACenteredCare

It makes sense for a #PharmD to call an MD for a script that THEY (using the years of schooling and clinical judgment that results) deem questionable. What doesn’t make sense is mandating this and using it as an excuse to deny patients their RXs. It’s cruel.

Also, what you don’t see here is once the PA is sent in, it will automatically be rejected. And when the second one is sent, that one will also be rejected. They will give different reasons each time. The process starts all over again when the appeal to the actual ins. co begins.

So let’s say Anthem uses Caremark for RXs. Once Caremark rejects both PAs, the patient must do a new “last chance” appeal. Because they ins co doesn’t communicate with the PBM as far as PAs, the whole process starts over with the 3rd PA.

Many MD offices have a policy in place now that says they won’t appeal. (Because they assume the notes they already sent would be sufficient).The distraught patient, which is most likely going through w/d at this point, must navigate how to deal with this.

So when a policy like this is put in place, patients that are already on these meds are basically force-tapered. BUT not by their MDs.

Caremark actually put an additional policy in place the only way they’ll approve a script for non-cancer pain med is if the MD/patient agree to taper to 50 MME. So they’ll approve a 90 mme script (after 3 appeals) as long as the dosage is being reduced. A NEW PA is req every 3 mo

GIVE UP. That’s the message here. And overall, in America. Patients have to GIVE UP their lives b/c of gov’t interference with the practice of medicine. It’s a wonder I’m still here.