Drug switching saves money, but the patients have to wait

After Joy McCormick was hospitalized with high blood pressure, her doctor prescribed two doses daily of a brand-name drug. Her prescription drug plan administrator balked. McCormick paid $67 out-of-pocket for her refill.

"Somebody at the insurance company is saying what kind of pills we can have or can't have," McCormick said Tuesday. "A doctor should be the one that says what is required."

McCormick is a participant in Medicare Part D, the prescription drug benefit that's new this year for Medicare beneficiaries. Private insurers, HMOs and associations operate the various government-subsidized prescription drug plans.

After intercession by both her pharmacist and primary-care doctor, McCormick was taken off Norvasc and put on a larger dose of Lisinopril, which is a generic drug. The 71-year-old Carson City woman had to wait about three weeks for this decision, something she said caused a greater amount of stress.

"It's very exasperating when your mom is sick and she needs medicine," said her son, Keith McCormick. "It makes you angry and you feel powerless."

Drug switching such as this is common, said Carson City pharmacist Mike Hautekeet. Often patients have to be pre-authorized for a certain brand-name drug, which can be difficult in cases of emergency medical care.

"Doctors have to try and get the pre-authorization, or switch them to other drugs, but it takes awhile to get it all changed," he said. "At the end, the patient still suffers because they have to wait for so long."

Switching to a less-expensive generic drug is an established practice with HMOs, pharmacy benefit managers and health plans, said Charles Duarte, administrator of the state Division of Health Care Financing and Policy.

"In general they follow standard medical practice and guidelines," he said. "I think its an odd situation for one to advise against what a doctor is suggesting for what was medically necessary."

Preferred drug substitutions are established by a pharmaceutical and therapeutic committee, he said.

Part D is the first time Medicare beneficiaries have had government-subsidized prescription drugs.

After the problems she's had, McCormick is wondering if she'll be paying for her blood pressure medication next month, or if it will cover the cost. Her Lisinopril costs $26, of which she only had to pay $2. So far it's working just as well, she said.

• Contact reporter Becky Bosshart at bbosshart@nevadaappeal.com or 881-1212.