Pity the Poor Bean Counters

There’s an article in the New England Journal of Medicine about the “Unintended Consequences of Four Dollar Generic Drugs“. Ever one to hone in on unintended consequences of all stripes, I quickly clicked through. Oh dear! What bad could possibly come of making drugs significantly more affordable? Were more people demanding prescriptions for drugs they didn’t really need now that they were so cheap? (Dream on. I’m still twisting arms to get my high-risk cardiac patients to take their generic statins.) Were pharmacies going out of business, no longer to make ends meet without massive markups on brand name drugs, contributing to skyrocketing unemployment and otherwise adding to the country’s general economic malaise? Were cardiologists’ incomes plummeting because of sagging rates of coronary disease, now that everyone could easily afford their beta blockers, ACE inhibitors, and statins? Or maybe it was something good.  I guess technically, “unintended” doesn’t automatically equal “bad”. What could it be?

So I read. And what did I discover?

It turns out that once people start paying cash for cheap generic drugs, their insurance companies can no longer keep tabs on their prescription drug use. Even though a patient may be taking all the medications recommended by guidelines for their conditions, those cash prescriptions won’t show up in the database, so it looks (to the insurance company, that is) like the patient is getting substandard care. Oh noes!!

For FSM’s sake, all you need to do is implement a national database for prescriptions (part of my version of an ideal EMR). And just to shut up the privacy Nazis before they get started, all that information is already being gathered by the insurance companies, who have no incentive to do anything other than mine it for information they can use to pry more of your hard-earned benjamins out of your pocket. Trust me; despite what you think you’ve heard about it, the government doesn’t care what drugs you take. The cheaper the better as far as they’re concerned.

If the worst thing about four dollar generics is that they screw up the ability of a couple of megacorporations to worm their way into my medicine cabinet, more power to them (generics, that is). After all, what’s more important: being healthy, or making sure some nameless, faceless pharmacy benefits manager knows you’re healthy?

The hell with the bean counters. Drop those prices, and let the cheap prescribing continue.