Dr. Kavorkian Where Are You?
(Column: Ask the Pharmacist)
HMOs are letting us die
Steve Kaufman, RPH
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Do we all remember Dr. Kavorkian? He was the doctor who helped terminally ill patients commit suicide. Dr. Kavorkian believed in euthanasia, the process of painlessly putting a terminally ill patient to sleep for eternity. This way they could die with dignity rather than spending the last few months of their life in constant pain and becoming a burden to their family and friends.

The purpose of this article is not to discuss whether the practice of euthanasia is morally right or wrong. What I would like to discuss is how I believe this practice is far more humane than what many insurance companies and third party administrators are doing to their terminally ill patients.

First let's define what an insurance company and third party administrator are. A health insurance company is a company that is hired and agrees to pay for your medical bills in case you get sick or are injured. A third party administrator is a company hired by the insurance company to run the plan for them. Those of you who have insurance cards will notice that they may say their plan is administered by Medco Health, Caremark, Express Scripts or Advance PCS. These are a few of the third party administrators out there.

For thousands of years when patients weren't feeling well they went to see their doctor. The physician examined and if necessary gave them a prescription for medication, which they took to the apothecary (pharmacy) to fill. If the doctor felt more extensive treatment was needed he would send the patient to a specialist like a cardiologist. Recently, over the last 10-15 years, many insurance companies have decided that this system does not work. Now many insurance companies send you to a doctor of their choosing to receive a medication of their choosing. If your doctor decides you need a specialist, many times the insurance company will decide if you can actually see one and which specialist you can see.

A doctor who believes in euthanasia will only perform it on a rational terminally ill patient who understands what is involved and is willing to accept the end results. The question I ask is if you withhold a patient's life-saving medications, are you assisting in suicide? Performing euthanasia? Committing murder? Or just torturing patients.

Over the last several months, I have had an alarming number of patients being denied medications by their insurance companies or third-party administrators. These medications include heart, blood pressure, diabetes and asthma medications just to name a few. I have had patients in the pharmacy with severe asthmatic attacks being told they had to mail away for the medications and will receive it in 2-4 weeks. In August, New York State announced it was going to sue one of the nation's largest pharmacy benefit managers, Express Scripts, Inc., for pocketing as much as $100 million dollars that should have gone to the state. According to an AM New York article, Attorney General Elliot Spitzer said, "They were simply committing fraud." In the July Daily News, Harvey Wachsman wrote an article titled Stop the HMOs Before They Kill Some More. In the article, he explains how HMOs are not held accountable for any decisions they make.

Mr. Wachsman states, "As it stands now, they can get away with what amounts to murder, avoiding any meaningful punishment even when they make egregious and callous decisions that cost people their lives." It seems to me that it is far more profitable for an insurance company to let a sick person die than to save their life. So, what are we to do? The laws seem to favor the insurance companies. We have to get the laws changed.

Filing complaints is part of the answer. If you feel you've been wronged, complain! File complaints with your benefit administrator at work. Write letters to your elected officials and file complaints with the New York State Department of Insurance. This mess we are in did not happen overnight and is not going to be fixed overnight but we better start working on it soon.
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