Sensible Medication Refills

Medications will drive you up the wall as a physician. You would think that the simple act of evaluating a patient and prescribing a medication would be rather easy, but it's not. 90 or 30 day supply? How many refills? Generic or brand name? Are we going to e-scribe or print it out? Is that medicine on the patient’s particular insurance formulary? Do I need to fill out a prior authorization for it? All these things take up time throughout the day that clinics could use to see patients.

Many insurance companies don't make this very easy. As physicians, we see patients with a myriad of different insurance plans all day. It's impossible for us to accurately keep track of what each insurance formulary says. It's also exceptionally difficult for us to always keep track of which mail order service or pharmacy your insurance company prefers.

As much as I can, I try to steer folks towards the $4 list. Wal-Mart started this and now most pharmacies have a similar list. You can manage the vast majority of conditions effectively with meds from this list. The trick is reminding patients to not run their insurance when they buy the medication. Ironically, these $4 medications can often cost you more than $4 if you use your insurance. 

From a physician efficiency perspective, I’ve often wondered about the way we prescribe medications. We must write both how many days’ supply to dispense as well as number of refills. As I consider this, I wonder why we do this? As a physician, do I really care if the insurance company prefers you have 90 days’ supply? What if they preferred 47 days or 102.6 days? The number doesn’t matter to me. 

When a person with high blood pressure comes for their appointment and I give them 30 days’ supply with 5 refills, the punchline is that I want them to have 6 months’ worth of that drug. Why don’t we just say that? The insurance companies and pharmacy can then work out exactly how that is dispensed. Let me move on to the next patient and not have to take the phone call back from the patient asking for a new prescription because their insurance company prefers 90 day supplies. If their insurance company has that preference, then their insurance company can take that phone call.