As I have stated before… I temp in LTC… When you are expected to review >60 Rxs/hr plus a another handful of tasks, do don’t always ready all the fine print… Last night something caught my eye… It was physician authorization for a substitute due to a non coverage by an insurance company.
On this form… which is sent to the prescriber…. there is the following statement :
The alternative(s) listed below MAY NOT be a therapeutically equivalent, but represents covered formulary options for the patient’s insurance plan.
So it would appear that as far as insurance companies are concerned… generic substitution… is so yesterday… therapeutic interchange .. is close enough is good enough… have we SUNK down to a level that whatever is the closest and the cheapest… is the only therapy that the insurer is going to approve… of course, .. you can go thru the prior authorization process.
In this particular incident.. the patient’s order was for generic DUO-NEB… the substitute that was approved the two ingredients in the DUO NEB dispensed separately… For those who know little/nothing about respiratory care… by going this route… the total volume in the nebulizer goes from 3 ml to 5.5 ml and the total treatment time… will move from 15-20 minutes to close to 40 minutes.
The typical COPD patient expends TEN TIMES the calories breathing than a normal patient… So “sucking” on a nebulizer for 15-20 minutes is very tiring for the patient… most can’t even begin to finish a 40 minute treatment.
I have had nurses tell me that they CUT the therapy at 15 minutes… so some pts only get MAYBE ..HALF of the therapy they are suppose to get !… Does this mean that other types of COPD therapy is now being given to patients .. with a greater overall therapy costs… more nursing time… more chances of mis-doses and other inherent complications of poly-pharmacy…
Are we saving pennies and wasting dollars?
Filed under: General dumb-ass problems
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