When your doctor hands you a prescription, you probably assume it’s for the best possible treatment. In a perfect world, that would be true. But in reality, hidden influences affect doctors’ drug-prescribing habits, often to the detriment of patients.
For starters, insurance companies can nudge doctors to prescribe from their drug formularies — lists of which medications are covered on a particular policy.
“Often insurance companies have preferred versions of blood-pressure medications, cholesterol-lowering drugs, and others,” says Dr. Davis Liu, a board-certified family physician with the Permanente Medical Group in Sacramento and author of “The Thrifty Patient: Vital Insider Tips to Staying Healthy and Saving Money.”
By prescribing from the formulary, a patient will usually pay less but might not get the drug that works best.
Pharmaceutical companies also influence physicians’ prescribing habits. In recent years, the U.S. Food and Drug Administration has cracked down on drug company payments, incentives, and paid vacations provided to physicians, says Jack Fincham, professor of pharmaceutical and administrative sciences at Presbyterian College in Clinton, S.C.
But subtler influences remain. Doctors are often given free samples of drugs and they may give those medications preferential treatment when it comes to prescribing.
Medications promoted with samples tend to be brand-new and/or expensive or existing drugs that were recently approved for other uses. They may also be new versions of existing drugs that are about to go off-patent “so the pharmaceutical company is trying to get patients to switch to the newer product, which will have patent protection” and thus be more expensive, Dr. Liu explains.
So what can you do? Ask your doctor the following questions about the medications prescribed for you:
• Do I really need this medication?
• Is this the best drug for my condition?
• What are the alternatives?
If your insurance doesn’t cover the drug your doctor believes is best, he or she “can request in writing that the insurance company pay for an alternative medication that’s not on the list,” Dr. Liu explains.
If the insurance plan gives the green light, based on your doctor’s letter, your medication will be covered.
Think twice about taking medication samples “unless the doctor can provide the entire treatment with the free samples — for, say, a bladder or skin infection,” Dr. Liu says.
The concern is that if a doctor gives you an expensive sample medication for high blood pressure and it works, he or she will be reluctant to switch you to a more affordable but perhaps equally effective medication, thinking why mess with success?
It’s usually best to “nudge your doctor into choosing effective, less expensive medications,” Dr. Liu says. “If you don’t, it is very likely you may unwittingly pay more for your medications, particularly as insurance companies shift more of the out-of-pocket costs to consumers.”
If you suspect your doctor’s decisions are being influenced by drug companies, a new online tool developed by ProPublica, a nonprofit organization dedicated to public interest journalism, can help.
The organization’s online
Prescriber Checkup lets you gauge your doctor’s prescribing habits compared to others in your state or zip code.
This way, you can find out how often your physician prescribes certain brand-name medications or whether your doctor prescribes drugs that aren’t commonly used — information that can help you have a more informed discussion with your doctor about which meds are best for you.
The full version of this article appeared in Health Radar newsletter. To read more, click here.