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How Hip Health Plan helps breed superbugs

I realize that tales of HMO ripoffs are a dime a dozen but I have to vent:

After two weeks of suffering through my annual bout of sinusitis/tonsilitis, I recently buckled and talked to my doctor about getting some antibiotics. I asked for Augmentin - it's worked well for me in the past... and that's what he prescribed: a 14-day supply of Augmentin XR 1000 MG.

When I go to pick up my meds, the pharmacist informs me that my insurer - HIP - will only authorize a 10-day supply at one time. In order to get the remaining pills, I'll have to wait until I finish the first batch and come back again. Why on earth does HIP have such a policy? Is the drug not approved for the formulary? Nope, it's there. Is 10 days the standard dosage? No, the standard dosage is either 14 or 28 days.

No, the reason HIP covers less than a full supply is Because it wants two co-payments out of me. At $30 each, that makes the drug $60. This not only makes the drug unduly expensive, but  it encourages patients not to take their full course of antibiotics.... which, if you know anything about antibiotics, is dangerous from a public health perspective, because it can lead to drug-resistant bacteria.

Anyway, I plan on calling HIP to complain - as soon as its member phone line is up and working.

CORRECTION 12/26/05: It turns out that the pharmacist was wrong and that Augmentin is typically prescribed for 10 days. Still annoying, but not nearly as unreasonable. Thanks to commenter Michael.

Posted by carrie on 12/19/2005 | Permalink

Comments

I would say that HIP is doing the correct thing. They are not trying to get extra copays out of you. If you look at the manufacturers recomended prescription guidelines (at http://us.gsk.com/products/assets/us_augmentin_xr.pdf) you would see that the recomended course of treatment is 10 days of 2 tablets every 12 hours for Acute bacterial sinusitis (see chart on page 12). If anyone wants to sell more of a drug, it would be the drug company, but they say 10 days is plenty. The standard for good insurance companies is to follow the standards set by the AMA and the research that the drug companies supply. This appears to be what happened here.

Michael Blank

Posted by: Michael A. B. | Dec 22, 2005 9:14:38 PM

Not a problem. I am glad you ammended your post. I did see some sketchy items about HIP as well that makes me think they do not have good corporate direction.
I actually do work at a health insurance company and things like this are one of the cheif complaints that I see. 99 times out of 100, the reasoning we use is based on medical data provided through AMA approved studies or FDA approved drug research. There are cases where we MIGHT make decisions based on costs, but those are mainly based on matters of convience to the member, not on their health.

Posted by: Michael A. B. | Dec 27, 2005 12:12:32 PM

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