Doctors blast plans over drug approvals

Physicians at the AMA Annual Meeting say interference by pharmacy benefit managers and burdensome preapproval procedures slow down the practice of medicine and disrupt the doctor-patient relationship.

By Victoria Stagg Elliott, AMNews staff. July 8/15, 2002.

Darlene Lawrence, MD, a family physician based in Washington, D.C., prescribed an oral antifungal for a patient with an infection in the toenails. But her judgment that this was what the patient needed wasn't enough for the insurance company's pharmacy benefit manager to approve payment. Instead, Dr. Lawrence was asked to either do a fungal culture on the patient's toenails or provide toenail clippings -- procedures that would take six to eight weeks.

"That's ridiculous," she said. "We could've sent toenail clippings off the floor."

That story, though, is a fairly benign example of the interference in medicine by nonphysicians that many doctors at the AMA's Annual Meeting last month decided to rebel against. These physicians are tired of having their judgment constantly questioned in the name of cost control.

"They're being the doctor," said Dr. Lawrence. "And imposing on our care in the name of decreasing cost."

A fungal infection in the toenails is rarely fatal. But, increasingly, physicians are warning that insurance companies' efforts to control costs may have serious health implications for patients.

Dr. Lawrence, for example, has had patients with gastric disorders self-treat with alcohol because they were unable to get timely insurance coverage for proton pump inhibitors.

"They end up in the hospital with GI bleeds," Dr. Lawrence said "Then that's a hospital bill. Why won't [insurers] just give them the medicine?"

Most get the medication they need eventually, if they come back, but she says the waiting time and hurdles are endangering her patients and making them suffer. [...]