What's your perception of pharma vs insurance companies?

I suspect most physicians (myself included) know very little about the specifics of insurance company formulary decisions and negotiations. Also, with the number of employed physicians growing ever larger, fewer of us give much consideration to the policies of the companies with whom we contract because it's not really our decision (unless we want to quit our job entirely over it). You know us doctors - we'd rather complain about it than think about it!

I hope you don't feel I'm evading your question, but here's my take-

These issues are just a result of the bizarre third party payor marketplace health care has become. Once upon a time, health insurance was like homeowner's insurance or car insurance - it protected you in a catastrophe, otherwise it paid nothing. A real marketplace dictated the price of drugs, office visits and even minor procedures. Now behind the scenes negotiations, rebates, and contractual adjustments have completely removed that very basic, extremely important marketplace experience in which a patient can decide whether a non-urgent, elective medication or intervention is worth the price. I'm sure some backroom deals are sketchier than others, but they're a symptom, not the disease. A third party payor system subsidized by our government is the problem. (IMO, not just in the sense of lobbying and collusion but also including the employer based tax incentives that started this mess spiraling out of control 30 or 40 years ago by moving health insurance from catastrophic to pseudo-pre-paid health care.)

Thanks for your compliment and your questions, though I'm not sure how satisfied you'll be with my answer.

 

Thanks for your post. Maybe I'll throw out some branded medications that I keep as samples as, in general, samples are branded meds that I consider unique and important enough to have on hand for consistent use in various situations. This is not an exhaustive list, but the first that come to mind. You (and others) can chime in if there is specific interest in why I regard one or more of them as particularly valuable or if you wonder if I intentionally decline to stock something specific.

Advair
Symbicort
Spiriva
Tudorza
Cymbalta
Victoza
Bydureon
Levemir
Bystolic
Viibryd
Dexilant

 

Can you elaborate/clarify re: the Victoza/Bystolic comment? I hope you don't mind my asking you to do so, but in the past on Cafepharma, I've misinterpreted sincerity for sarcasm and vice versa. Either way, thanks for your post; I just want to make sure I understand your perspective.

 

Thanks for the clarification!

Yes, I think these two meds are unique enough that there is a small but significant patient population for whom they are a great fit. They are not "me too" drugs in the way I think of them, although, I must confess that it took me while to come to that conclusion about Bystolic.