Out in the Community

Posted by Alex at Wednesday, August 11, 2010

My first rotation as a P4 is Sam's Club. Unlike many pharmacy students, I have never interned at a community pharmacy. My background is inpatient pharmacy, clinical research and managed care. Since I just completed a summer internship in managed care, I find it quite interesting to start off the year with my community rotation.

One of the biggest issues that patients face is insurance. "Your insurance won't cover your med until next week." "Your insurance will only cover a certain number of pills." As a result, quite naturally most people would think insurance companies are evil and don't look out for the good of patients.

As part of the rotation, we are required to do an educational poster. For my topic I'm thinking of doing a poster on basic managed care terms and principles: formulary, tier, co-pay, prior authorization, quantity limit. I really want to educate people on these topics so they can at least get some understanding of what happens when they are paying for their medicine.

A comment that one of the techs said resonated within me: "If the doctor writes a prescription for a drug, the insurance should just pay for it."

Doctors don't always put cost or the patient's insurance into account when selecting drug therapy. So I would have to disagree with that statement. Furthermore, the managed care organizations base their decisions on what gets covered or not on the very same clinical practice guidelines and primary literature that health care providers base their decisions on.

I believe if patients are aware of what meds their insurance covers and lets their doctor knows while the prescription is being written, a lot of hassle could be avoided. The patient does not have to wait around for their med to be filled only to find out the insurance does not cover it, and then have to wait longer for pharmacy to reach the doctor to change the med. Therefore, as part of my project I'd like to inform patients that they should really let their doctor know what insurance they have and what meds are covered.

Just now I googled Blue Cross Blue Shield's formulary indicating which meds are tier 1, tier 2, tier 3. It took me 5 seconds to pull up the list.

Through this project I believe I can be a true patient advocate in helping patients access their medications.

As cliche as this may also sound-- all experiences, regardless of what type of experience, really does enrich learning.