Guest Blog: Prescription report cards

Dr. Ed Pullen is a family physician who sees patients at Sound Family Medicine in Puyallup, WA. The following piece is excerpted from a previously published post on his blog, DrPullen.com.

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Twice a year, each of the major health insurance plans sends me a report card showing how I compare to my peers on prescribing generic medications, formulary medications, and overall cost of medications. For a few years, I always felt good about these reports. I consistently look favorable when compared to my peers. I figured I was doing my part to control the cost of health care. I don’t believe that having good insurance and being able to afford the higher tier co-payments for brand name expensive meds is a good enough reason to skip less expensive generics when I have reason to believe the less expensive meds will be more efficacious. I try to be both informed and conscientious in attempting to manage the costs of prescriptions for my patients. Probably as a result I always look pretty good on the comparison graphs.

Diabetes is one of the conditions where use of only generic medications simply will not get many patients to the goals we are encouraged to pursue. I am proud to be a Diabetes NCQA and Bridges to Excellence Diabetes Recognized Provider, but am certain this would not be the case if I didn’t prescribe the medications I’m encouraged to find alternatives for on these report cards. I’m also encouraged to substitute an ACE inhibitor for any patients I have on an angiotensin receptor blocker (ARB). I know that I rarely prescribe an ARB to patients who have not had unacceptable side effects, usually refractory cough, from an ACE inhibitor. I am reminded of the minority of my patients who are on trade name SSRIs or SNRIs for depression, and non-generic statins. Most of these have been prescribed by their psychiatrists or their cardiologists, and it is difficult for the primary physician to get these substituted if the patient is at goal for their LDL numbers, or is doing well from a mental health standpoint.

Overall, now I look at these reports as what I believe they really are, marketing propaganda insurers use to show prospective large company buyers of their product what they are doing to keep the costs of medical care low. What I’d really like to see is more helpful information from insurers, like which of my consultants spends more money than others in treatment of various conditions. Then I can use the information insurers are the best at collecting to refer patients to specialists whom I believe provide quality care (which I am better positioned to judge than the insurers), and who are cost-conscious as well.

I’d also like to have insurance companies contact my patients directly to get them to have their preventive services done. Rather than scold me for not having all my female patients between the ages of 50 and 65 up-to-date on their mammograms, why not notify them and ask them to see me for an examination and referral? I am already working hard on my patients' health and disease management. Third party payers could make better use of their data than merely sending me report cards on costs of my prescriptions. They could be encouraging patients to get their preventive and disease management care done, too.