More Trouble With The Drug Plan

First, it was just incompetent implementation. Now it's just plain old red tape. NYTimes (02.14.06):

"Doctors and pharmacists say many drugs theoretically covered by the new Medicare drug benefit are not readily available because of insurers' restrictions and requirements. The benefit is administered by scores of companies under contract to Medicare. Each plan has its own list of covered drugs, known as a formulary. Drug plans require doctors and patients to obtain 'prior authorization' for certain drugs on their formularies." Rules of Medicare Drug Plans Slow Access to Benefits

And that's where the fun starts. "The procedures vary by plan. One plan may have 25 or 30 forms for prior authorization for different drugs. Most states have at least 40 Medicare drug plans." So with 25 forms and 40 plans, doctors and pharmacists could be dealing with around 1000 different forms. Man. This isn't just any old red tape here. We're talking Hall of Fame. Doctors say the requirements are such a pain in the ass that they "can delay or deny access to needed medications." Insurers say "the requirements save money and promote the proper use of the medications." Wait a minute. Wouldn't it be the doctor who determines the proper use of a medication, not the insurance company? "Ross W. Brickley, a pharmacist in Kinston, N.C., said he had requested prior authorizations for hundreds of drugs taken by Medicare patients in more than 20 plans, each with its own policies, forms and procedures." "'We have a world of chaos,' Mr. Brickley said." "David W. Bernauer, chairman of Walgreen, one of the biggest drugstore chains, echoed that concern. 'It is impossible for pharmacists to keep track of all these formularies' and prior authorizations, Mr. Bernauer said." Have a complaint? Not a problem! There's a couple of forms you need to fill out.