A doctor writes prescription, pharmacist fills prescription, insurance covers prescription. Simple, right? But that’s not the way it works anymore.
Some changes are good. Gone are the cryptic abbreviations and illegible handwriting — replaced by computer printed scripts, or better yet scripts magically transmitted via the ether. But along with fewer errors there’s even less transparency on pricing and coverage. Patients, who haven’t been to pharmacy school and couldn’t possibly decode the pages of exclusions and conditions in their insurance contract, get hosed. And doctors and pharmacists get blamed.
Remember this, if nothing else: it’s all gamed by the payer. Insurance company tricks are there to prevent them from spending money on your health care, while making your doctor and pharmacist look bad. Insurance companies are often abetted by pharmacy benefit managers (PBMs) – middlemen who skim even more health care dollars off the top, adding another layer of screwage.
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