Read on Twitter
Today I did a 2-page prior auth so a patient could get 2 tablets of azithromycin to treat her chlamydia. Because @Aetna has been dicking around trying not to cover a generic, readily available medication, it's now almost 2 weeks since diagnosis & she hasn't been treated yet.
I've done prior auths for a thousand other medications but this is a first for me. Isn't it cost-saving to treat STIs before they become PID, cause infertility, or get passed along to a partner? Why would an insurance company make it harder (or impossible!) to get treated?
Also: 1g of azithromycin is the CDC-recommended treatment for chlamydia. It's a ONE-TIME DOSE, it's not experimental, there's no real debate about whether or not it's a first line agent, & the alternative is a 7-day course of different antibiotics that aren't any cheaper.
I'm just having a hard time getting my mind around why Aetna would fight this, unless it's just to second-guess every treatment decision and hope some patients and/or providers will just give up. After all, for-profit insurance companies make money by denying care.
And just in case you're interested, here are the executive salaries for Aetna's leadership: https://www.salary.com/tools/executive-compensation-calculator/mark-t-bertolini-salary-bonus-stock-options-for-aetna-inc?year=2017
Adding to this thread to address some things that have been mentioned: yes, I get that the patient could theoretically have paid between $10-20 cash to get the medication. HOWEVER...
...she doesn’t have ready access to a car and will now need to make another trip to a pharmacy (and maybe not the one closest to her). She will either need to pay for a ride or use transit. That’s not only extra cost, it’s additional Covid risk.
For someone on a tight budget, $20 plus transit/ride service could be enough to mean no groceries for the week. I see lots of patients who have to decide between food and healthcare, which is absurd in a country with so much wealth.
No one should have to take up a collection, take out a predatory payday loan, or choose not eat in order to pay for necessary medication.
The patients I have the privilege to care for are already so amazingly resourceful that if they tell me they can’t afford their meds, I believe them. I know they’ve already stretched their resources thin and they’re left with a menu of terrible choices.
