Would you think to check your prescription bag before leaving the pharmacy? Well, you should. Pharmacists may be switching your prescriptions without you or your doctor's permission.Your prescription may be getting "bagged and tagged."
Officially this is called a therapeutic substitution, the practice of replacing a medication with a drug that is not chemically equivalent, but is still in the same therapeutic class and is also approved to treat the same condition. Colloquially, this is called "bag and tag."
Your prescription is being bagged up and tagged shut before you ever get to take a look, and now you're stuck with the generic drug, one that your doctor did not prescribe.
Insurance companies are using their power to force therapeutic substitution onto patients. Business executives at insurance companies are making decisions regarding your health rather than your doctor. The decision to implement therapeutic substitution is entirely money driven without concern for the patient's health.
Have you received a letter from your insurance company telling you that your current name-brand drug is no longer covered and that you will be subject to step therapy? You are being coerced to take a cheaper drug that may not be as clinically effective as the drug initially prescribed by your doctor.
Why? Primarily because the brand-name drug companies will not offer insurance companies discounts or kickbacks, therefore the insurance companies are requiring you to take a cheaper, possibly less effective drug.
There are obvious dangers of therapeutic substitution. The new drug may have different side effects and interactions with other drugs, side effects that neither the pharmacist or insurance company is aware of. Doctors and patients need to be informed of therapeutic substitution in order to deal with the potential problems.
For example, I have patients on a brand-name cholesterol-lowering drug and some patients have received a letter in the mail notifying them that it will no longer be covered under their benefit plan unless they satisfy a step therapy criteria. This means the individual must now change from a therapy that has proven to be effective for them and gamble their health by trying several generic cholesterol-lowering drugs. There is no regard for the patient's health in this scenario, just a decision based on greed.
Another way this situation could go is that I may mark on the written prescription, "brand name only," but when the patient gets the prescription home they find that the medical instructions have been disregarded and a generic has been dispensed. They have become the latest victim of bagging and tagging.
We see this happening more and more as pharmacists are getting kickbacks from their employers and insurance companies for dispensing generic drugs. Three months ago we would get a call from the pharmacists asking permission for a generic drug switch from the brand-name drug to "save the patient money." Now I do not even get a call.
Running my own private practice, I have been able to avoid the pressure big insurance companies put on salaried doctors to prescribe generic drugs. I take a risk by not being guaranteed an income with my practice, but being able to empower, educate and treat my patients as best I possibly can is worth the risk. I do not have an annual generic drug quota I need to meet each year, nor the risk of having to pay a fine if I do not meet it. Many companies offer their doctors and pharmacies incentives to prescribe and dispense generic drugs, as the cost is much less. Insurance companies are severely limiting the options to both doctors and patients by not including brand-name drugs in their benefit plans.
More needs to be done to ensure that patients receive the treatment that their doctors find best for their individual medical situations. Therapeutic substitution is putting insurance companies in charge of your health rather than you and your doctor.
It is important for you to be confident in your doctor and the decisions he or she is helping you to make.
It is important to understand why your insurance company is asking you to switch medications mid-treatment and why your prescription is secretly being switched at the pharmacy.
Stevenson lives in Ogden.
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