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Press 1 for Transparency: Prescriptions, Health Insurance, and the Need for Reform

If I didn’t hate going to the pharmacy so much, I’d conduct a social science experiment in CVSes, Duane Reades, and Rite Aids around the country. It would go something like this: I’d take a seat in one of those plastic waiting-area chairs, and with a pad of paper disguised behind a People magazine, I’d begin a tally. In a given day, how many of the people who try to pick up a prescription are waylaid by a problem with their insurance? Judging from the anecdotal evidence I gather during my own visits each month, I’m willing to bet that the numbers are astounding.

The snippets of conversation between pharmacy techs and customers vary only slightly: a customer tries to refill a prescription two days too soon—until the refill date, insurance won’t cover the cost (forget one or two extra pills of leeway); the co-payment has gone up; the insurance company doesn’t approve that high a dosage of a certain prescription even though the physician ordered it and the dosage is medically indicated; only generics of that prescription are covered. My best friend encountered just such a problem the other week. We stopped in the pharmacy to pick up a prescription that she’d filled a half dozen times before, only to find that her co-pay had inexplicably gone up $15. When she asked the technician about the increase, she was met with a shrug and the refrain, “Call your insurance company.” Needing her prescription, she forked over the extra cash, but as soon as we were outside she regretted that she’d given in so easily.

At a time when politicians and policymakers are demanding “transparency”–from companies benefiting from the bailout, from the changing presidential administrations – it’d be nice to add health insurance to the mix. As it stands, the only thing transparent about it is insurance companies’ badly disguised motives–saving money and turning a profit. Of course, these motives are only part of the problem. With endless silos of information and insurance plans that change faster than Apple updates its iPods, it’s no wonder that pharmacists and customers are clueless when a prescription can’t be filled, or has doubled in price, or isn’t covered at all.

I wish I were more optimistic about the possibility of meaningful transparency. Just last month I received a letter from my insurance company, saying that it has decided to outsource its prescription coverage to Caremark, a subsidiary of CVS. I didn’t take it as a good sign that when I logged on to my online insurance account, I was prompted to create a new, separate, CVS-controlled account in order to access my prescription information. It makes sense that electronic medical information should be kept secure, but to separate prescription information from other information is just silly. If ease of accessing information is another term for transparency, then my own insurance has miles to go before it can be considered transparent.

In our fragmented health care system, I’d like to see transparency begin with straightforward answers about denied claims, phone lines that don’t redirect you to multiple automated agents, and pharmacy techs who can offer more than a befuddled look when asked about insurance coverage. Surely these improvements would have to be part of the health care reform plans that are anticipated at some point after Inauguration Day. But I’m adding it to my Christmas list, anyway: just under affordable prescriptions and lower co-pays.

Alison Jost is Program Coordinator and a former research assistant at The Hastings Center.

Published on: November 25, 2008
Published in: Health Care Reform & Policy

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