- By Milt x_Zall
- Feb 18, 2001
If you are enrolled in the Blue Cross and Blue Shield Service Benefit Plan, trouble lies ahead for you if you take certain prescription drugs that Blue Cross thinks aren't being properly used.
As part of its patient safety and quality monitoring program, Blue Cross officials say certain prescription drugs are being dispensed at a level higher than is appropriate. Apparently, Blue Cross officials think they know more than your physician about what medicines you should take. And that's without an examination. Pretty impressive. I think I'll go to Blue Cross for my next checkup!
Indigestion medication is one prescription drug being targeted. According to Blue Cross, there are two classes of prescription drugs used for this ailment. The first group is H2-blockers, such as Pepcid and Zantac, and the second group is proton-pump inhibitors (PPI), such as Prilosec and Prevacid. Medicines in the first group cost less than the PPIs. So naturally, Blue Cross wants feds to use more of the H2-blockers and less of the PPIs.
As a result, Blue Cross is limiting the annual use of PPIs to 90 capsules or tablets. If your doctor thinks that's not enough, he or she can call Blue Cross to request an extension. That's placing an impossible burden on both the doctor and the patient. I have no problem with Blue Cross and other plans asking us to have our doctor fill out a form explaining why we need certain medications. But telling us that we are entitled to only 90 pills a year is an affront to all of us and shouldn't be permitted to continue.
Blue Cross claims there is a tendency for some patients to continue taking PPIs after they are no longer necessary, or for a period of time that's longer than is recommended by the Food and Drug Administration. But you can't get prescription drugs without a doctor's prescription. So if someone is taking PPIs longer than what the FDA recommends, it's because the doctor thinks it is necessary. The FDA recommendations are simply guide-lines, not mandates. Also, physicians often discover that a drug designed for a particular disease is also beneficial for combating other diseases. Is Blue Cross going to try to block this practice? Last I heard, this is still a free country.
In an HMO, there may well be a tendency to try to cut corners by prescribing drugs that cost less. I thought that when you enroll in a fee-for-service plan such as Blue Cross, you choose the doctor you're going to use and your doctor decides what medications you take and for how long. Not Blue Cross.
For Blue Cross to interfere with the doctor/patient relationship is outrageous. I urge all readers affected by this program to write to the Office of Personnel Management and their congressional representatives. This has to stop.
Zall is a retired federal employee who since 1987 has written the Bureaucratus column for Federal Computer Week.