Here’s why health care isn’t working. My doctor provided a sample medication that cured my symptoms, so she prescribed it for me. The insurance company denied it. To quote from their letter, “The medication is not on your formulary. To approve non-formulary you must have previously taken at least two medications on the formulary that didn’t work or caused side effects.” I suspect that means, “the prescribed medication is costlier than two other available prescriptions.” So I, the patient, must try two medications that may fail or have negative side effects.
Seems the insurance company would rather pay for two trials that fail and then pay for a third medication, rather than pay once for one that works. Meanwhile I’m frustrated, subject to three copays, a delayed cure and the doctors are buried in paperwork to justify what they prescribe. Could paying for three prescriptions be costlier than paying for one?
Since when do insurance companies decide what medications are best for me? I’m positive that my doctor knows best, since I’m being treated by her and not the insurance company clerk. The insurance company’s “tail” is absolutely wagging the medical industry’s “dog,” This is absolute stupidity.
Gabe Lyons, Richland