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Physicians Still Waiting for Flexibility in Prescribing to Suicidal Patients

The Heartland Institute

By Madeline Peltzer

In 2012, the American Psychological Association (APA) stated “pharmacy benefit management companies should offer prescribing physicians flexibility in determining when dispensing of an entire 90-day supply of a medication is clinically dangerous and should offer alternatives that would enable dispensing a 90-day supply in multiple shipments without financial penalty.”

           Insurance companies began promoting 90-day supplies in the belief that it would improve patient compliance with their drug regimen and save money because it would cut dispensing costs and allow pharmacies buy drugs in bulk.

           Giving a three-month supply could be problematic, however, for patients in danger of drug overdose. “Physicians must make repeated phone calls and faxes, diverting valuable time away from patient care,” wrote Brian Barnett, M.D., a Cleveland, Ohio- based psychiatrist in the Wall Street Journal, February 6. “Few insurers have streamlined processes for physicians to obtain insurance coverage for small medication quantities.”

           It is not just suicide but addiction that concerns physicians, says Merrill Matthews, scholar at the Institute for Policy Innovation, and policy advisor to The Heartland Institute, which publishes Health Care News. “I have heard doctors complain that they plan to prescribe, say, a 30-day supply of a pain reliever after surgery, but then be pressured to make that 90 days, even if there is no justification. That opens the door for abuse.”

Overdose Deaths on the Rise

In a 2018 Centers for Disease Control and Prevention report found that from 2000-2016, the age-adjusted suicide rate increased 30 percent to 13.5 per 100,000 people. Suicide is the 10th leading cause of death in the United States. While suffocation and firearms are the most common means of death for most age groups, male and female, suicide from drug overdose is significant, especially for older females.

            Drug overdose is also on the rise, in large part to the opioid crisis, but determining whether an overdose is accidental, or an act of suicide has been difficult to discern. “Without psychological/psychiatric evidence contributing to manner of death classification, suicide by drug intoxication in the U.S. is likely profoundly under-reported,” states a January 2018 report by the National Center for Biotechnology Information. 

Missing:  A Free Market Approach

The concern about overdose deaths points to the need for greater personalization in medical care and health insurance to empower doctors, says Robert Emmons, M.D., psychiatrist and policy advisor to The Heartland Institute. 

            Under the current system, insurers, employers, and the government pay the vast majority of medical expenses. As the ones footing the bill, large organizations decide what they will cover and how much they will pay. “In general, any third-party involvement whatsoever in the specifics of clinical decision-making, such as quantities of pills dispensed, is problematic,” said Emmons. “Third parties always represent interests other than those of individual patients. Always.”

           A free-market approach to coverage would allow consumers and their physicians to decide the best course for treatment, says Matthews. “Drug companies depend on the prescribing doctors, who are the check-and-balance in the system,” said Matthews. “They are the only ones in a position to determine what's best for their patient. They need to be able to tell the dispensing pharmacy what their patient needs and no more.”