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Wednesday, April 30, 2003Faced with higher co-pays or restrictions on prescription coverage, some patients might start self-diagnosing and self-medicating with over-the-counter antihistamines, said Dr. David Lang, head of allergy and immunology at the Cleveland Clinic Foundation. ``There's the issue of misdiagnosis,'' Lang said. ``In other words, not everyone who comes to us has hay fever.'' Patients might think their stuffiness is caused by seasonal allergies when, in fact, they're suffering from a chronic sinus infection or even hormonal changes caused by pregnancy or use of oral contraceptives. Another major concern: Patients who self-treat their symptoms might miss other, more serious conditions, particularly asthma. But anti-histamines have been available over-the-counter for years. Clairitin isn't any more effective at suppressing allergy symptoms than the previously available drugs - it just does it with fewer side effects. There's no reason to think that people will suddenly start to ignore their asthma in greater numbers (something which a lot of people unfortunately already do) because they have yet another anti-histamine to chose from. Of course, the real issue here is that people are being asked to bear a greater burden of the cost of the drug: Allergy sufferer Jody Yoxthimer, a 30-year-old Akron resident, used to pay an $11 co-pay each month to get a version of Claritin that included a decongestant. When she recently called her pharmacist to see whether it would be covered, she discovered her insurer wouldn't pay for the drug anymore. So rather than pay $30 each month for Claritin, plus more for a decongestant, Yoxthimer is switching to a drug that's still available only with a prescription. She said ``The thing is, the idea of having the prescription drug go over-the-counter is so you can buy it without a prescription and it's not expensive. Claritin was really working well.' She might have been paying only $11 for prescription Claritin, but it was much more expensive than the current over-the-counter price of $30 for others: Before the switch, Akron's SummaCare Health Plan, for example, paid roughly $2.25 to $2.50 per tablet for Claritin -- or $67.50 to $75 for a 30-day supply. The customers of that health plan, in turn, paid a $40 copay for the drug, plus whatever it took in higher premiums for the company to cover extra drug costs. But it's so much easier to complain about the insurance companies than to accept responsibility for our share of the cost burden: In the meantime, some insurers are making people jump through new hoops to get their prescription; they have to prove they've tried an over-the-counter alternative without success. ``The insurance companies are essentially practicing medicine without a license by restricting access to medications that patients need,'' said William E. Berger, an allergist in Mission Viejo, Calif., and president of the American College of Allergy, Asthma and Immunology. ``Our position is, physicians should be the ones to make the decisions about what's appropriate for patients -- not insurance companies.'' Well, they're not really practicing medicine or restricting our practice. We can still recommend the antihistamine, but the patient is going to have to accept that those antihistamines are safe enough to be offered over-the-counter and paid for in cash rather than through the beneficence of their insurance company. And honestly, if your allergies are bad enough to require daily medication, is one dollar a day for the average consumer that much of a burden? posted by Sydney on 4/30/2003 09:13:00 AM 0 comments 0 Comments: |
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