Opinion: Insurers shouldn’t stand in the way of patients’ treatment
As a certified nurse practitioner working in primary care, I’ve spent the last eight years treating and interacting with patients every single day.
In that time, not enough has been done to address one of the biggest challenges facing Michigan patients — a lack of adequate access to the medicine they need. My official clinical diagnosis is simple — the process for prescribing lifesaving medications in this country is a disaster, and the lion’s share of the blame lies at the feet of health insurance companies.
Because of red tape and regulations like requirements that physicians and nurse practitioners obtain authorization from an insurer before prescribing, restrictive formularies that push patients towards older and less effective medicines, and because of recent insurance plan changes that no longer apply copay coupons to a patient’s out-of-pocket cap, many of my patients are struggling to get the medicine they need.
Unfortunately, simply knowing a patient needs a specific medicine is no guarantee that patient will have access to that essential treatment. One of the biggest barriers standing between patients and their prescriptions are health insurance practices — particularly a myriad of confusing prior authorization requirements — designed to put the insurance company’s bottom line above the health and safety of Michigan patients.
Here’s how the crisis unfolds. First, a patient comes to the office for a visit. We do an exam, we run the tests, and we make a diagnosis. Next, we work with the patient to identify a treatment plan, and that sometimes includes a prescription medication. So the patient — who has insurance — simply goes to the pharmacy and picks up her medicine, right?
Instead, the patient’s health insurance company steps in and determines whether it will cover the patient’s medicine or not based on profit margin, not how badly the treatment is needed.
Sometimes, the insurer requires a long and difficult prior authorization process that delays a patient’s access to the medicine she desperately needs. Sometimes the insurer denies the patient access to the medicine she needs altogether and requires her to first use a less effective or ineffective alternative medicine.
That leaves the patient with a choice; use the less effective medicine and suffer the health consequences, or pay more out of pocket for the medicine that works best while her insurer continues to pocket her monthly premium.
In other words, insurance companies often will not approve new medications and will delay medical progress and patient treatment to boost their bottom line. This is unethical.
How much harm are we doing by allowing insurance companies to delay and deny our patients the care they need?
In many cases this also traps patients in an expensive medical cycle. If they can’t get the proper medications to treat the condition, the condition advances, comorbidities occur, functional status declines, and the wheel turns with no chance for the patient to get out of it.
In a system that is already breaking, practices like this will only further divide the medical field, patients and the nation.
Jordana Latozas is a certified nurse practitioner treating patients in Metro Detroit.