http://www.bloomberg.com/news/articles/2016-06-27/pharmacy-managers-unleash-big-data
But with the easiest savings already in the past, OptumRx and rivals such as CVS Health and Express Scripts have begun mining their huge troves of prescription data in search of economies…
UnitedHealth began laying the groundwork for the data push in 2011, when it grouped an array of businesses under the Optum brand. In a recent case, the company noticed that at one client, drugs for attention deficit hyperactivity disorder were being overprescribed to adults. Some were using the drug to improve their performance at work, according to Andrea Marks, chief analytics officer at OptumRx. The benefit manager took action, saving the 19,000-worker company $110,000…
For chronic pain patients, you’ll see insurance companies limiting the type and amount of prescription drugs you’re allowed to use for treatment. And they’ll use the new CDC rules to support their decisions.
You can always appeal any decision like this, but it will involve patience, time, and probably paying your doctor to document your need for the treatment. Most of the stories I’ve read about appeals have been favorable for the patient, but be prepared for a fight.
Sumit Dutta, OptumRx’s chief medical officer, says the company makes sure its coverage decisions are medically appropriate. “All of those have to be vetted clinically first,” he says. “You can’t say one drug is favored over another drug unless you’ve fully vetted that clinically.” …
To favor one drug over another is discriminating against the patient population that will achieve a benefit from the non-favored drug. But then, when all you care about is making money, you don’t really care about discrimination.
I’ve done some reading about the history of health insurance companies, and maybe we needed them in the past, but we really don’t need them now. It’s just one more layer of clueless people telling patients which services and medications they’re allowed to have access to, while we’re the ones paying for this intermediary.
One of the reasons our health care is so expensive is because we’re paying for the whole insurance industry to be involved with our medical decisions. Funny, but it was doctors who created the health care insurance industry, and now it’s the industry that’s helping to financially destroy doctors. I believe that’s called irony, and on quite a large scale.
Like this:
Like Loading...