Re: Formerly Formulary

[Linda J Herman <ljherman1@xxxxxxxx>]

Art,
    When ReQuip was first prescribed for me, in conjunction with Sinemet
CR, our HMO also rejected payment with a computer generated "not in our
formulary" message. This was a few months after it's FDA approval. My
neuro called the HMO and had a long, heated discussion with them.
According to the information they had, ReQuip was a substitute for
Sinemet, and they questioned why both were being prescribed. He was
finally able to make them understand the benefits of it's use as an
addition to Sinemet - mainly being able to keep the Sinemt dosage lower.
He was angry too that he had to justify his prescription to people at the
HMO who were not MDs.  Maybe it needs to be presented in economic terms -
that correct drug therapy now could help prevent or delay complications
and  more costly claims at at later date. Have there been any studies
about this?
      I know I am fortunate to be dealing with a locally based HMO,  a
pharmacist who has taken a personal interest and a neuro who is willing
to advocate for his patients. As you said, all  of our individual drug
prescription problems really need to be dealt with on a national policy
level.
  Linda