G.G, FACP, sued PBMX to collect on the time he spent filling
out two or three prescription inquiries a week, each taking between six and 10
minutes to complete. He told PBMX in December 2005 that he would bill $150 an
hour to fill them out, and when PBMX said they would not pay, he sued in 2006.
The
courts decided March 6 of this year that PBMX's prescription inquiries were
designed to examine whether the prescriptions were the most economical for PBMX, and since they were solely for PBMX's benefit, Dr. G.G. could collect
payment for his time.
The following is by Dr. G.G. (The bold, underlined emphasis was added):
Pharmacy Benefit Management Companies are the illegitimate children of an affair
between insurance companies and the pharmaceutical industry; they interrupt the
interaction between the patient and the doctor (as well as the pharmacist) at
the point of service with a remote control mechanism that is entirely wasteful,
mercenary and redolent of what Enron did with distribution of energy. It is a
perfect setup for corruption. If all PBMs were forced out of business today,
everyone would be better off.
I did not file this case against PBMX to make money. I filed it to prove a
legal point, which so far seems to have worked.
The point is this: if a PBM not acting at the request or on behalf of the
patient demands my time in order to fill out forms (for the enrichement of the
PBM) authorizing the dispensing of my prescriptions, then a) it is obligatory
for me given the PBMs privileged position, b) my time in complying with the
"prior authorization request" is worth something more than nothing.
This would only be suitable for class action status if every doctor in
the suit was following evidence based medical principles, and giving
appropriate consideration to patient safety first and of cost of the
medications second when prescibing medications. When those conditions are met
PBMs have nowhere to hide.
This is a critical time for doctors in the U.S. If we do not stand up as
patient advocates and resist greed and corruption, then we have little chance
of transforming health BUSINESS back to health CARE. We are all ambassadors for
a sacred profession. It remains sacred only if we permit our thoughts and
actions to preserve it as such. We have more science and technology to draw
from than any generation of doctors that have preceded us, and that is a
priceless gift we can share with our patients. In the 2000 report of the WHO,
the U.S. ranked 37th among 193 member nations in quality of health care, but
first in cost per capita. It is our fault to unless we work individually and
together to mend a broken system.
"You never change things by fighting the existing reality.
To change something build a new model that makes the existing model
obsolete"
- Buckminster Fuller
