Vermontís patients arenít one size fits all, and their choices in prescription medicine shouldnít be, either. A single prescription drug formulary structure has been proposed for Vermont, but it doesnít make sense for patients and the state. Inefficient for patients, financially ineffectual and administratively burdensome, a single formulary system makes it harder for patients to receive the care they deserve, at a cost that makes sense.
As background explanation, a prescription benefit management (PBM) plan makes contracts to lower the price of drugs purchased for the state, but they can also limit a patientís options for treatment, especially when there are several kinds of medications available to treat the same condition. Those limitations, or formularies, can make it harder for patients to receive the right medication at the right time, or remove the best available medication from the management plan.
If cost savings are the premise for such dire risks to patient health, then letís take a hard look at the facts. Spending on innovative medicines makes up only about 3.5 percent of all federal spending in Medicaid. Professional services, hospital care, administration, home health, nursing facilities and residential care make up the remainder.
Patients may have a trial-and-error process when they fill a prescription, which may lead to non-adherence with a prescribed treatment plan. For instance, under a single formulary, a patient may take his prescription to be filled by a pharmacist, only to be told that the medication is not covered. Leaving the patient without his medication can derail a therapeutic plan, in the end costing the patient and the state more.
We understand the stateís need to try to reduce costs associated with health care, but there are other ways to achieve those ends. Adding another layer of bureaucracy could make it harder for physicians to do their jobs and ultimately could have a negative effect on patient care.
Medicines arenít always interchangeable, and the limitations of a single formulary and substitutions that would be required can have a dire effect not just on patient choice, but on their overall health. As a 2009 Health Affairs article cited (m.content.healthaffairs.org/content/28/5/w832.full), in addition to projected cost savings due to a single formulary being murky (at best), limitation on a patientís drug formulary can have clearly negative therapeutic effects.
The treatment of Parkinsonís disease and its side effects requires a delicate balance of prescription medications. Substituting less expensive or generic drugs, or not being able to obtain the correct combination, can often undermine progress made over a long period of time, which makes having the right choice of prescription drug plans absolutely critical for these individuals.
Vermonters who have prescription drug plan options available through Medicare Part D are able to make educated, informed choices about which plan provides them with the best, most affordable coverage. But a single formulary will eliminate this choice and would impact low-income Medicare beneficiaries the most.
Shutting out patients from a physicianís primary treatment decision isnít the right answer for Vermont. Letís rethink our approach; itís not just about how we approach costs. A single formulary is also relevant in thinking about how we pay for value and care for our patients.
Michael OíConnor is president of the Vermont chapter of American Parkinsonís Disease Association Inc. He lives in Williston.MORE IN Perspective
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